In this episode of the EMCrit podcast, I discuss how to perform the tests that will differentiate a peripheral cause of continuous vertigo from a cerebellar stroke. David Newman-Toker & Jorge Kattah, neurologists at John Hopkins, have done a ton of work on this topic.
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I will discuss what all of these terms mean and how to perform the exams in the podcast. Here is a link to another study by the same authors on head impulse testing. Insanely good systematic review on Dizzy Stroke Patients (CMAJ 2011;183(9): E571) and maybe the best review on Vertigo ever!
and here is a fantastic journal club from EM Journal Club with Dr.
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What if I told you that I think that patient you just sent home with vertigo may have been a missed cerebellar stroke?
Would you be dialing risk management or could you tell me all of the reasons why I’m wrong?Isolated vertigo without other neurological findings can’t be a stroke, right?That is true, if you are doing the right exam, but if you are just doing your standard ED neuro screening exam then you might be missing serious pathology.At higher doses it may result in slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes.Doses of sedatives such as benzodiazepines, when used as a hypnotic to induce sleep, tend to be higher than amounts used to relieve anxiety, whereas only low doses are needed to provide a peaceful effect.Sedatives can be misused to produce an overly-calming effect (alcohol being the classic and most common sedating drug).