The Curbsiders Internal Medicine Podcast

REBOOT #49 Vertigo and Dizziness: How to Treat, Who to Send Home, and Who Might Have a Stroke

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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. Original show notes here.

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Show Segments

  • Intro, Getting to know our guest
  • Clinical Case
  • Why can’t patients describe their dizziness?
  • Classifying dizziness
  • The 3 vestibular syndrome buckets defined
  • Episodic vestibular syndrome differential diagnosis
  • Acute vestibular syndrome differential diagnosis
  • Chronic vestibular syndrome differential diagnosis
  • Challenges of medical history taking
  • Approach to the acute vestibular syndrome/HINTS
  • How to evaluate nystagmus
  • How to perform the head impulse test (aka head thrust)
  • How to perform “test of skew” (alternate cover testing)
  • Recap of HINTS exam and discussion of MRI
  • Signs and symptoms of cerebellar stroke
  • Use of Dix-Hallpike for episodic vertigo
  • What happens when you choose the wrong test
  • Continuous versus triggered dizziness, or vertigo
  • Meclizine use in BPPV
  • How to cure horizontal canal BPPV
  • Treatment for vestibular neuritis
  • Treatment for Meniere’s disease
  • Who benefits from vestibular rehab/exercises
  • Dizziness and giddiness
  • Take home points
  • Outro

    • Credits

    • Produced and Written by: Cyrus Askin MD
    • Show Notes: Matthew Watto MD
    • Hosts: Cyrus Askin MD, Stuart Brigham MD, Matthew Watto MD, FACP; Paul Williams MD, FACP
    • Editor: Matthew Watto MD, FACP
    • Guest: David Newman-Toker MD, PhD

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