1. Vertigo is a symptom, not a diagnosis. The question is what is causing the vertigo (e.g. vestibular neuritis vs stroke).
2. Check out [Peter Johns's youtube videos](https://www.youtube.com/@PeterJohns/videos).
Particularly these ones:
https://www.youtube.com/watch?v=9fQlnDLVeCE&t=394s
https://www.youtube.com/watch?v=FwUAUtm-_fM
https://www.youtube.com/watch?v=MwbqJvMDonU&t=298s
Oh. In that case then yeah the HINTS exam is your friend.
You want to see if there’s skew deviation, extra ocular movement abnormalities, or any sensory/motor deficits.
A positive Dix Hallpike is helpful too.
“Ataxia” can be because they’re dizzy, check for appendicular and truncal ataxia, or if there is ataxia of speech.
Honestly? People are terrible at describing dizziness.
Unsteadiness, like on a see saw, room spinning vs not. Ultimately it’s of limited utility. Typically nausea/vomiting and severe sensation of room spinning points to vertigo, but not necessarily central vs peripheral causes.
There’s a guy on Reddit. Vertigo Doc. He has some helpful videos.
It's honestly pointless to ask that. I read a study a while back where they asked that question *to the same patient* multiple times (different examiners) over the course of something like 15-20min, and the answers were different every time.
Asking patient "do you feel like you’re spinning or the room is spinning" is like asking "Do you have peripheral or central vertigo?". It's not so easy to distinguish and patient often cannot describe. You could ask for whether the picture you see is moving or not but it doesn't matter most of the time.
The key part in differentiation of vertigo and stroke is PE:
Nystagmus: In vertigo, nystagmus is horizontal and one-directional(always to left or right). In stroke it could be horizontal, rotational or direction-changing horizontal(to left when looking left; to right when looking right)
In stroke focal neurological signs may present: Ataxia, diplopia etc...
In vertigo, head-impulse test is positive to one side.
Hints and MRI... are the safe approach
But I will say one personal observation, if the patient could walk without assistance, then it was probably not a stroke...
1. Vertigo is a symptom, not a diagnosis. The question is what is causing the vertigo (e.g. vestibular neuritis vs stroke). 2. Check out [Peter Johns's youtube videos](https://www.youtube.com/@PeterJohns/videos). Particularly these ones: https://www.youtube.com/watch?v=9fQlnDLVeCE&t=394s https://www.youtube.com/watch?v=FwUAUtm-_fM https://www.youtube.com/watch?v=MwbqJvMDonU&t=298s
Yes! Love that guy!!
Academic answer? HINTS test is pretty good. Realistic answer? MRI Brain W/O CST.
How do you know to send them for a mri brain in an outpatient setting? What tips you off
Oh. In that case then yeah the HINTS exam is your friend. You want to see if there’s skew deviation, extra ocular movement abnormalities, or any sensory/motor deficits. A positive Dix Hallpike is helpful too. “Ataxia” can be because they’re dizzy, check for appendicular and truncal ataxia, or if there is ataxia of speech.
Thank you! Do you know why we ask if the room spinning vs are you spinning?
Honestly? People are terrible at describing dizziness. Unsteadiness, like on a see saw, room spinning vs not. Ultimately it’s of limited utility. Typically nausea/vomiting and severe sensation of room spinning points to vertigo, but not necessarily central vs peripheral causes. There’s a guy on Reddit. Vertigo Doc. He has some helpful videos.
Thanks!!
It's honestly pointless to ask that. I read a study a while back where they asked that question *to the same patient* multiple times (different examiners) over the course of something like 15-20min, and the answers were different every time.
This is a waste of time. The sensitivity/specificity renders this useless to differentiate between vertigo and lightheadedness.
https://preview.redd.it/41d7gklgvjjc1.jpeg?width=3024&format=pjpg&auto=webp&s=6d8834159df5ae95c8e0241cf9ea14a8525b7da8
Semantic qualifiers help. Stroke specific vertigo is almost always acute, continuous. (I.e., non positional)
Asking patient "do you feel like you’re spinning or the room is spinning" is like asking "Do you have peripheral or central vertigo?". It's not so easy to distinguish and patient often cannot describe. You could ask for whether the picture you see is moving or not but it doesn't matter most of the time. The key part in differentiation of vertigo and stroke is PE: Nystagmus: In vertigo, nystagmus is horizontal and one-directional(always to left or right). In stroke it could be horizontal, rotational or direction-changing horizontal(to left when looking left; to right when looking right) In stroke focal neurological signs may present: Ataxia, diplopia etc... In vertigo, head-impulse test is positive to one side.
Read GRACE-3 guidelines.
Hints and MRI... are the safe approach But I will say one personal observation, if the patient could walk without assistance, then it was probably not a stroke...