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

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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