The Curbsiders Internal Medicine Podcast | MedEd | FOAMed | Internist | Hospitalist | Primary Care | Family Medicine
#49: Vertigo and Dizziness: How to Treat, Who to Send Home and Who Might Have a Stroke
Manage episode 183393436 series 1345893
A simplified approach to dizziness/vertigo with tips from international expert, Dr. David Newman-Toker, Professor of Neurology, Ophthalmology and Otolaryngology at Johns Hopkins University. We learn how to differentiate stroke from other causes of dizziness/vertigo; how to approach the differential diagnosis in dizziness/vertigo; how to perform the Dix-Hallpike test, Epley maneuver, and HINTS exam; plus, who benefits from medical therapy and vestibular rehab.
Special thanks to Dr. Cyrus Askin who found our expert, wrote the questions for this episode, and acted as our cohost.
Full show notes available at http://thecurbsiders.com/podcast
Case: A 45-year-old man presents to the emergency department because of continuous dizziness, nausea, vomiting and unsteady gait that began 18 hours earlier.
04:16 Getting to know our guest
11:56 Clinical Case
13:13 Why can’t patients describe their dizziness?
15:20 Classifying dizziness
18:35 The 3 vestibular syndrome buckets defined
22:14 Episodic vestibular syndrome differential diagnosis
26:49 Acute vestibular syndrome differential diagnosis
28:08 Chronic vestibular syndrome differential diagnosis
30:15 Challenges of medical history taking
32:10 Approach to the acute vestibular syndrome/HINTS
33:38 How to evaluate nystagmus
38:00 How to perform the head impulse test (aka head thrust)
45:56 How to perform “test of skew” (alternate cover testing)
47:45 Recap of HINTS exam and discussion of MRI
50:50 Signs and symptoms of cerebellar stroke
55:17 Use of Dix-Hallpike for episodic vertigo
57:00 How to perform Dix-Hallpike
59:50 How to perform the Epley maneuver
64:17 What happens when you choose the wrong test
66:10 Continuous versus triggered dizziness, or vertigo
67:40 Meclizine use in BPPV
69:25 How to cure horizontal canal BPPV
71:00 Treatment for vestibular neuritis
72:56 Treatment for Meniere’s disease
74:32 Who benefits from vestibular rehab/exercises
77:23 Dizziness and giddiness
78:15 Take home points
Tags: vertigo, dizziness, presyncope, ataxia, stroke, BPPV, Meniere’s, disease, neuritis, vestibular, syndrome, episodic, meclizine, migraine, gait, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student
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