Diagnosis and treatment of acute vertigo in emergency neurological practice

The diagnosis and treatment of acute vertigo in emergency neurological practice are among the most pressing issues in modern neurology. The diagnosis of vestibular system disorders remains at a low level. Many patients with peripheral vestibular system damage and vestibular migraine are misdiagnosed with stroke and transient ischaemic attacks, chronic vertebrobasilar insufficiency, and cervical osteochondrosis. Acute vestibular vertigo is in most cases associated with pathology of the peripheral vestibular system and vestibular migraine, and much less often with stroke or transient ischaemic attacks in the vertebrobasilar arterial system. To make a diagnosis, it is especially important to conduct a clinical neurovestibular examination, including positional tests for benign paroxysmal positional vertigo, the Halmagyi (head impulse) test, assessment of oblique deviation, severity of trunk ataxia and hearing impairment, as well as the use of modern neuroimaging methods. Modern treatment regimens have been developed for each of the nosological forms. A low-dose combination drug of cinnarizine 20 mg + dimenhydrinate 40 mg in combination with vestibular rehabilitation has shown high efficacy in the treatment of vertigo.