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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