1. EachPod

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

Author
The Curbsiders Internal Medicine Podcast
Published
Mon 05 Sep 2022
Episode Link
https://audioboom.com/posts/8151818

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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