ORIGINAL ARTICLE   Open access

Italian Journal of Emergency Medicine 2022 April;11(1):19-24

DOI: 10.23736/S2532-1285.22.00091-X

Copyright © 2022 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.

language: English

Diagnostic predictors to discriminate between central and peripheral vertigo in the Emergency Department

Ilaria FUCILE ¹, Luigi BASILE ¹, Claudio CONTE ¹, Stefania AUCIELLO ², Filomena LICCARDI ², Fiorella PALADINO ², Nicola DE LUCA ¹, Costantino MANCUSI ¹ ✉

¹ Department of Advanced Biomedical Science, Hypertension Research Center, Federico II University Hospital, Naples, Italy; ² Caldarelli Hospital, Naples, Italy

BACKGROUND: Vertigo, dizziness and light-headedness are responsible of 3% of presentations to the Emergency Department (ED). Peripheral vertigo is the most common cause of vertigo represented by the benign paroxysmal positional vertigo (BPPV). Only the 4-6%, is caused by a serious cerebro-vascular disorder including stroke, neoplasm, or demyelinating disease. In the ED is crucial to rapidly discriminate between central and peripheral vertigo because to identify central vertigo in a timely manner can be lifesaving for the patient. The aim of this study was to evaluate predictors of central vertigo among patients admitted in ED with acute vertigo/dizziness based on demographic and clinical characteristics.
METHODS: This retrospective observational study was conducted with adult patients admitted for vertigo to the ED of Antonio Cardarelli Hospital in Naples (Italy) between October 1 and December 31, 2017. Demographic characteristics, presence of associated signs and symptoms, past medical illness and pharmacological anamnesis were assessed.
RESULTS: Of the 202 patients included in the study, 9 patients (4.45%) received a final diagnosis of central vertigo. Eight variables (cephalgia, focal neuro signs, confusion, antidiabetic therapy, arterial hypertension, antiplatelet therapy and antihypertensive therapy) are significantly associated with a diagnosis of central vertigo. Furthermore, the multivariable regression model revealed that clinical presentation with cephalgia, focal neuro signs, confusion and antidiabetic therapy were predictors of central vertigo.
CONCLUSIONS: This study suggests that among patients presenting with vertigo in ED, those with cephalgia, focal neuro signs, confusion and antidiabetic therapy are at the highest risk for a cerebrovascular etiology.

KEY WORDS: Vertigo; Emergency service, hospital; Dizziness