Zulfiqar Rana, MD, MPH, FACP
Board Certified in Internal Medicine
Category Archives: Neurology
Dizziness and Vertigo
January 9, 2020
Posted by on 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 2
Dix Hallpike Maneuver
The Romberg Test
Updated Guidelines on Secondary Stroke Prevention – Neurology
March 13, 2011
Posted by on About one in four strokes that occur annually are recurrent events. The American Heart Association/American Stroke Association has now updated its 2006 evidence-based recommendations for the prevention of stroke among survivors of ischemic stroke or transient ischemic attack (TIA). The guidelines include recommendations, rated by class (degree of treatment effect) and evidence level, for risk-factor control, antithrombotic therapies, interventional approaches for atherosclerotic disease, and treatment of unusual stroke mechanisms.
via Updated Guidelines on Secondary Stroke Prevention – Neurology.
Epley’s
March 1, 2011
Posted by on This exercise works great for BPPV, a kind of vertigo. Try it and see if it works for you.