π΅βπ« Does the differential for dizziness make your head spin? Need help finding your balance in the world of vertigo?
Let's break down how to approach the confusing consults for βdizzinessβ π x.com
Let's break down how to approach the confusing consults for βdizzinessβ π x.com
β οΈ Donβt ask how it feels! Dizziness descriptions are wildly unreliable π
Of >1300 patients, 62% select multiple types when given options, 52% don't re-pick the same descriptors just 6 min earlier, and 70% who initially denied vertigo later endorse it when specifically asked. x.com
Of >1300 patients, 62% select multiple types when given options, 52% don't re-pick the same descriptors just 6 min earlier, and 70% who initially denied vertigo later endorse it when specifically asked. x.com
π© Is all hope lost? No! π
Use the evidence-based TiTrATE approach:
- Timing
- Triggers
- Associations
- Targeted Examination
Use the evidence-based TiTrATE approach:
- Timing
- Triggers
- Associations
- Targeted Examination
β° Timing is key π
New, acute onset vertigo should be treated very differently than recurrent spells over the last couple weeks.
Constant dizziness lasting months could be walking dysequilibrium or functional.
New, acute onset vertigo should be treated very differently than recurrent spells over the last couple weeks.
Constant dizziness lasting months could be walking dysequilibrium or functional.
β»οΈ For recurrent attacks, triggers may the biggest clue π§©
- Head turning, rolling over in bed: BPPV?
- Postural relationship: Orthostatic Hypotension?
- Walking: Peripheral Neuropathy?
- Loud sounds: Semicircular Canal Dehiscence?
- Spontaneous & short: Vestibular Paroxysmias?
- Head turning, rolling over in bed: BPPV?
- Postural relationship: Orthostatic Hypotension?
- Walking: Peripheral Neuropathy?
- Loud sounds: Semicircular Canal Dehiscence?
- Spontaneous & short: Vestibular Paroxysmias?
π€ Associated symptoms are next π
- Nausea/headache: Vestibular Migraine?
- Pallor/diaphoresis: Presyncope?
- Unsteady in dark: Sensory deficit?
- Gradual buildup over 20+ min: Anxiety/hyperventilation?
- Hearing changes/tinnitus: Peripheral cause?
- Nausea/headache: Vestibular Migraine?
- Pallor/diaphoresis: Presyncope?
- Unsteady in dark: Sensory deficit?
- Gradual buildup over 20+ min: Anxiety/hyperventilation?
- Hearing changes/tinnitus: Peripheral cause?
Donβt be intimidated by the targeted exam.
A brief neuro eval can be very revealing.
Is there nystagmus?
- Yes, acute persistent: use the HINTS exam dx central vs peripheral
- No, normal exam: consider the Dix-Hallpike to diagnose BPPV
Donβt forget orthostatic vitals! x.com
A brief neuro eval can be very revealing.
Is there nystagmus?
- Yes, acute persistent: use the HINTS exam dx central vs peripheral
- No, normal exam: consider the Dix-Hallpike to diagnose BPPV
Donβt forget orthostatic vitals! x.com
Multiple-Sensory Defect Dizziness
When elderly patients say 'I'm dizzy,' think multiple causes
44% have >1 problem - mix of balance, vision, proprioception, vestibular loss, and meds
When elderly patients say 'I'm dizzy,' think multiple causes
44% have >1 problem - mix of balance, vision, proprioception, vestibular loss, and meds
TiTrATE transforms the dizzy consult from chaos to clarity.
Use it consistently and pattern recognition will follow.
Use it consistently and pattern recognition will follow.
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