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J Korean Soc Emerg Med > Volume 14(3); 2003 > Article
Journal of The Korean Society of Emergency Medicine 2003;14(3): 281-290.
Differentiation of Central and Peripheral Causes according to Clinical Features of Dizzy Patients in an Emergency Setting
Gab Teug Kim, In Han Song
Emergency Medical Department, Medical College of Dankook University, Cheonan, Korea. gtkim@medigate.net
Central dizziness infrequently develops to a cerebellar or brainstem infarction. However, in the acute phase, central lesions masquerade as peripheral causes. This study was performed to provide the diagnostic guidelines for differentiation between peripheral and central causes.
From January 2002 to December 2002, we investigated 307 dizzy patients with normal brain computerized tomography. The patients were analyzed according to age, history, associated symptoms, duration of attacks, neurologic examination, and tests of balance such as gait, tandem gait, and nystagmus.
The history of cerebral vascular accidents and neurologic symptoms, such as numbness, diplopia, dysarthria, dysphagia, or weakness, suggested central causes. Episodes of dizziness lasting seconds suggested benign positional vertigo. Dizziness associated with vertebrobasilar insufficiency typically last minutes whereas peripheral inner ear causes of recurrent dizziness typically last hours. Patients with peripheral or central causes have impaired balance, but this is more severe with central causes than with peripheral causes. Spontaneous nystagmus of a central origin changed direction with gaze to the side of the fast phase.
The history, the associated symptoms, and the tests of balance provided the key information for distinguishing between peripheral and central causes, and the guideline applied in this study will be helpful to diagnose the cause of the dizziness.
Key words: Peripheral dizziness, Central dizziness, Diagnostic guideline
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