#49: Vertigo and Dizziness: How to Treat, Who to Send Home and Who Might Have a Stroke
Published July 24, 2017
82 min
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    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

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    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.

    Time Stamps

    00:00 Intro

    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

    81:06 Outro

    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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