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Does This Dizzy Patient Have a Serious Form of Vertigo?

David A. Froehling, MD; Marc D. Silverstein, MD; David N. Mohr, MD; Charles W. Beatty, MD
JAMA. 1994;271(5):385-388. doi:10.1001/jama.1994.03510290067039.
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Patient 1  A 52-year-old woman was admitted to the hospital because of nausea, a constant spinning sensation, and vomiting of 24 hours' duration. Any movement of her head made these symptoms worse. On examination, she had bilateral horizontal spontaneous nystagmus. Two days later, after symptomatic improvement, she was dismissed. At follow-up 2 weeks later, her symptoms and nystagmus had completely resolved.

Patient 2  A 70-year-old woman had a 4-month history of an intermittent whirling sensation when turning her head and especially when rolling over in bed. On examination, a left-side-down head-hanging maneuver elicited rotatory nystagmus, with the fast component to the left ear (Figure). There was a latency of about 3 seconds before the onset of nystagmus, which lasted approximately 10 seconds.

WHY EVALUATE VERTIGO?  "Vertigo" is defined in Webster's dictionary2 as a disturbance "in which the external world seems to revolve around


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