The role of transcranial Doppler ultrasonography in differential diagnosis of vertigo in the Emergency Department

  • Antonio Siniscalchi | anto.siniscalchi@libero.it Stroke Unit, Department of Neurology, “Annunziata” Hospital, Cosenza, Italy.
  • Giovanni Malferrari Stroke Unit, Department of Neurology, Local Health Authority - IRCCS, Reggio Emilia, Italy.

Abstract

Vertigo represents about 4% of access to the Emergency Department (ED). Several conditions, such as general medical illnesses, otovestibular diseases and neurological diseases (including posterior circulation stroke) cause acute vertigo. The incidence of cerebrovascular disease in patients with vertigo in ED varies from 3 to 5%. Although neurosonology studies on acute vestibular syndrome are scarce, the use of transcranial Doppler (TCD) and transcranial color Doppler (TCCD) in the management of vertigo patients has several advantages: it can be performed at the patient's bedside and repeated and, furthermore, its use is low-cost. In an acute stroke, with an experienced doctor, it can help distinguish an ischemic stroke from a hemorrhagic stroke. In acute central vertigo induced by posterior circulation stroke, the TCD or TCCD can be a screening test before angiographic neuroradiological studies for stenosis of vertebral or basal arteries. As a matter of fact, the clinical outcome, particularly in the posterior circulation stroke, is mainly related to a rapid diagnosis and subsequent treatment that will be able to quickly restore the blood flow. In conclusion, TCD and TCCD are useful in the differential diagnosis of vertigo in the ED, although we recognize the indisputable importance of clinical examination as a first step in vertigo management. In the evaluation of patients with acute central vertigo due to suspected posterior circulation stroke, the use of TCD or TCCD can rapidly reveal steno-occlusive disease of the posterior circulation, arterial dissections and give indirect signs of vertebra-basilar insufficiency.

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Published
2019-10-01
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Section
Reviews
Keywords:
Vertigo, Emergency Department, Posterior circulation stroke, Transcranial Doppler, Transcranial color Doppler
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How to Cite
Siniscalchi, A., & Malferrari, G. (2019). The role of transcranial Doppler ultrasonography in differential diagnosis of vertigo in the Emergency Department. Emergency Care Journal, 15(3). https://doi.org/10.4081/ecj.2019.8341