The Curbsiders Internal Medicine Podcast5 Sep 2022

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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