Zulfiqar Rana, MD, MPH, FACP

Differential Diagnosis

From: AAFP

The TITRATE approach

From: TiTrATE: A Novel Approach to Diagnosing Acute Dizziness and Vertigo
David E. Newman-Toker and Jonathan A. Edlow

Work-Up

History:

• t-EVS
  • BPPV
  • orthostatic hypotension
  • DANGEROUS: internal bleeding, POTS, intrathoracic emergencies, intrabdominal emergencies.
• s-EVS
  • Meniere’s disease
  • vestibular migraine
  • vasovagal syncope
  • panic attacks
  • DANGEROUS: TIA (do ABCD’s) and cardiac arrhythmias
• t-AVS
  • post-exposure – blunt head trauma
  • post-exposure – medications esp. anti-convulsants, CO exposure, aminoglycosides
• s-AVS
  • Vestibular Neuritis
  • DANGEROUS: Stroke (lateral brainstem, cerebellum, inner ear), Wernicke’s encephalopathy, listeria encephalitis.

PHYSICAL EXAM:

• Vitals – BP
• Vitals – pulse
• vitals – orthostatic BP
• Gait and Romberg
• HInts exam
  • Head impulse
  • Nystagmus
  • Test of Skew
• Dix-Hallpike maneuver

LABS:

• CBC, CMP
• ?UA
• Imaging

Miscellaneous

HINTS exam

ARTICLE
https://www.emra.org/emresident/article/hints-exam/

VIDEO 1
http://www.kaltura.com/index.php/extwidget/preview/partner_id/797802/uiconf_id/27472092/entry_id/0_b9t6s0wh/embed/auto

VIDEO 2

Dix Hallpike Maneuver

The Romberg Test