The importance of head-thrust test in differential diagnosis of peripheral and central vertigo in patients presenting to emergency service with dizziness

Introduction: Dizziness is among the most common reasons that patientspresent for an evaluation[3] and its presentation at the emergency room (ER) with an incidence of 1.3-2.5%.[4,5] The report of symptoms can be vague, inconsistent, or unreliable.[1,2] Non-invasive, inexpensive, not time consuming, and easy to apply bedside testing is important for emergency medicine physician especially for the differential diagnosis of central vertigo.We aimed to investigate the role of the head-thrust test (HTT) in the differential diagnosis of peripheral and central vertigo in patients presenting to the ER with complaint of dizziness.Material and Method: This prospective observational clinical study has been carried out between 01.02.2011 to 31.07.2011 in Gazi University, Faculty of Medicine, Department of Emergency Medicine. Audiovestibular tests were performed in all patients in peripheral vertigo group and neuroimaging studies were performed in all patients in central vertigo group.Results: Dizziness/vertigo presentations have constituted 0.78% of all ER presentations. Patients in central vertigo group were significantly older (Mann-Whitney U, p=0.007) and with a diagnosis of hypertension and using antiagregant (Fisher?s exact test, respectively p=0.026 and p<0.001) compared with those in peripheral vertigo group. Their vertigo complaints were not significantly triggering with head movements (Pearson ?² test, p<0.001) compared with peripheral vertigo group. They also had vertical nystagmus pattern (Pearson ?² test, p<0.001) and normal HTT results (Pearson ?² test, p<0.001) significantly. Patients in central vertigo group were also had significantly more deficits in neurological examination (Fisher?s exact test, respectively p<0.001, p<0.001, and p=0.026 for tandem walking, Romberg, and knee-heel tests). Furthermore hospitalization rates, number of neuroimaging studies performed in the ER, and mean systolic blood pressure values were higher in central vertigo group. Benign paroxysmal positional vertigo, Meniere disease, and vestibular neuritis were the first three most frequent diagnosis in peripheral vertigo group.Conclusion: Using of the HTT by emergency medicine physicians may be important in terms of differential diagnosis. HTT is easy applicable, repeatable, and short duration test. This test does not require additional equipment or delay the patient?s treatment. Given the advantages of the HTT, it seems to be appropriate for the use of vertigo presentations in the ER.