- Key point is to discern between central and peripheral causes – become familiar with the nuances of one and concentrate on that
- Assume central and convince yourself its peripheral in nature, if at the end of the evaluation, you can’t do that, assume a central cause and do a work-up
- Using timing and characteristics to help you – intensity, inducible, fatiguable, constant or not, associated symptoms
- Always do a full neuro exam – finger to nose, heel to shin, and ambulate these patients – if they can’t walk, DO NOT DISCHARGE
- Perform bedside tests to help in your decision – Dix-Halpike, Romberg – know that we are not good at performing the HiNTS exam, so don’t rely on it
- MRI/MRA is the diagnostic study of choice if you thinks its central – do not hesitate to get this test if you think its a central cause
- Perform the Epley Maneuver with with the patient if you identify a BPPV – but only after you give medication – tell them to repeat the exam and give instructions on how to do so
REBEL Core Cast – Basics of EM – Dizziness
Click here for Direct Download of the Podcast
Co-Host:
Anand Swaminathan, MD
Twitter: @EMSwami
Post Peer Reviewed By: Anand Swaminathan, MD (Twitter: @EMSwami)
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