Zulfiqar Rana, MD, MPH, FACP

Board Certified in Internal Medicine

Category Archives: Neurology

Dizziness and Vertigo

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

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Work-Up


 

History:

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  • 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

Updated Guidelines on Secondary Stroke Prevention – Neurology

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

This exercise works great for BPPV, a kind of vertigo. Try it and see if it works for you.