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

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By Audioboom and The Curbsiders Internal Medicine Podcast. Discovered by Player FM and our community — copyright is owned by the publisher, not Player FM, and audio is streamed directly from their servers. Hit the Subscribe button to track updates in Player FM, or paste the feed URL into other podcast apps.
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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419 episodes