Which sequence correctly describes diagnosing cervicogenic vertigo?

Which sequence correctly describes diagnosing cervicogenic vertigo?

• A. Assess symptoms -> Exclude vestibular causes -> Evaluate cervical spine -> Diagnosis of exclusion
• B. Exclude vestibular causes -> Assess symptoms -> Evaluate cervical spine -> Diagnosis of exclusion
• C. Assess symptoms -> Evaluate cervical spine -> Exclude vestibular causes -> Diagnosis of exclusion
• D. Evaluate cervical spine -> Assess symptoms -> Exclude vestibular causes -> Diagnosis of exclusion

Answer: (A)

Cervicogenic vertigo is a diagnosis of exclusion, so the evaluation should proceed in a way that first confirms vertigo symptoms, then rules out vestibular causes, followed by assessing the cervical spine, with the final label given only after other etiologies have been ruled out. Begin by assessing symptoms to confirm that the patient truly has vertigo and to characterize its features—timing, triggers, and whether symptoms are linked to neck movement or head position. This helps distinguish true vertigo from non-vertiginous dizziness and guides the subsequent workup. Next, actively exclude vestibular causes. This means applying targeted history and examination and, if needed, vestibular tests to rule out peripheral or central vestibular disorders such as BPPV, vestibular neuritis, Menière disease, or central vestibulopathies. Only after these vestibular etiologies are reasonably excluded should you proceed with attributing symptoms to the cervical system. Then evaluate the cervical spine for factors that could contribute to dizziness, such as cervical proprioceptive dysfunction, neck muscle tension, and motion-related changes that could create mismatches between neck input and vestibular signaling. This step strengthens the plausibility that the neck is driving the dizziness when vestibular causes have been ruled out. Finally, with vestibular causes excluded and cervical contributors identified, you arrive at the diagnosis of cervicogenic vertigo—a diagnosis of exclusion.

Cervicogenic vertigo is a diagnosis of exclusion, so the evaluation should proceed in a way that first confirms vertigo symptoms, then rules out vestibular causes, followed by assessing the cervical spine, with the final label given only after other etiologies have been ruled out.

Begin by assessing symptoms to confirm that the patient truly has vertigo and to characterize its features—timing, triggers, and whether symptoms are linked to neck movement or head position. This helps distinguish true vertigo from non-vertiginous dizziness and guides the subsequent workup.

Next, actively exclude vestibular causes. This means applying targeted history and examination and, if needed, vestibular tests to rule out peripheral or central vestibular disorders such as BPPV, vestibular neuritis, Menière disease, or central vestibulopathies. Only after these vestibular etiologies are reasonably excluded should you proceed with attributing symptoms to the cervical system.

Then evaluate the cervical spine for factors that could contribute to dizziness, such as cervical proprioceptive dysfunction, neck muscle tension, and motion-related changes that could create mismatches between neck input and vestibular signaling. This step strengthens the plausibility that the neck is driving the dizziness when vestibular causes have been ruled out.

Finally, with vestibular causes excluded and cervical contributors identified, you arrive at the diagnosis of cervicogenic vertigo—a diagnosis of exclusion.