Vertiges en urgence

One person out of two has experienced (or will experience) dizziness at least once, and one out of seven acute vertigo. 5% of the patients seen by a GP have vertigo and/or disequilibrium. In 37% of the cases, patients are referred to a specialist. In 2%, a serious disorder is diagnosed: an embolic transient ischemic attack due to vertebral artery dissection, or basilar trunk dissection, affecting the posterior fossa. During diving, aero-embolic accidents affect more electively the inner ear, but sometimes severe medullary lesions may be associated. In fact, most of vertiginous patients coming to emergency departments present with benign positional paroxysmal vertigo (35%), first manifestations of a Ménière's disease (6%), or vestibular neuritis (6%); more rarely temporal bone fracture, or infectious complications such as the rare and severe infectious labyrinthitis. Knowing how to diagnose a transient ischemic attack of the posterior fossa, and being aware of adequate therapeutic strategies for each of the main causes of vertigo, are essential for the emergency doctor.