Progressive Neurologic Diseases and Dizziness: What You Need to Know

In this episode of Talk Dizzy To Me, vestibular physical therapists Dr. Abbie Ross, PT, NCS and Dr. Dani Tolman, PT sit down with Dr. David Sandlin, a vestibular and oculomotor neurologist at Emory Brain Health Center, to discuss how eye movements can provide critical clues to progressive neurologic diseases.

From Parkinson's disease and Progressive Supranuclear Palsy (PSP) to Multiple System Atrophy (MSA), cerebellar disorders, and Multiple Sclerosis (MS), Dr. Sandlin explains how a detailed bedside eye movement examination can detect neurologic disease long before imaging does. He shares the clinical reasoning behind evaluating nystagmus, saccades, smooth pursuit, VOR testing, and other vestibular examination findings that help differentiate central from peripheral causes of dizziness.

This episode also discusses the importance of making timely referrals and understanding where vestibular rehabilitation fits into the care of progressive neurologic disorders.

Hosted by:

🎤 Dr. Abbie Ross, PT, NCS

🎤 Dr. Danielle Tolman, PT

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This episode is for educational purposes only and is not a substitute for medical advice. Always consult a qualified healthcare provider for diagnosis and treatment. The views expressed by guests are their own and do not necessarily reflect those of the hosts.

Time Stamps:

00:00 – Introduction to Dr. David Sandlin

02:15 – Why Dr. Sandlin specialized in vestibular & ocular motor neurology

06:05 – What are progressive neurologic diseases?

08:15 – Can dizziness be the first symptom?

10:55 – How Dr. Sandlin evaluates dizzy patients

12:45 – Eye movement examination: fixation, nystagmus & ocular alignment

15:35 – Saccades and what they reveal about the brain

18:25 – Smooth pursuit, convergence & VOR suppression

21:50 – Why eye movements reveal so much about neurologic disease

24:20 – Vestibular testing beyond the bedside exam

26:10 – Red flag patterns of nystagmus clinicians should recognize

28:55 – Hypermetric saccades, stroke & cerebellar findings

30:20 – Pendular nystagmus and multiple sclerosis

32:10 – MRI: when imaging helps—and when your clinical exam is better

36:45 – Central vs. peripheral findings: what provides reassurance?

41:45 – Progressive Supranuclear Palsy (PSP): recognizing early signs

45:10 – Multiple System Atrophy (MSA), Parkinsonism & autonomic dysfunction

49:20 – AI, ChatGPT & patients researching their symptoms

51:00 – The future of AI-assisted eye movement analysis

53:00 – Virtual reality and the future of vestibular diagnostics

56:25 – Key takeaways for patients and clinicians