Speaker Disclosures: 12/4/2015 DIZZINESS AND NEAR SYNCOPE. I have no relevant commercial relationships to disclose
|
|
- Angelina Blair
- 5 years ago
- Views:
Transcription
1 DIZZINESS AND NEAR SYNCOPE Bernard Gran, M.D. Neurologist, Co-Chief, Department of Neuroscience Baptist Health Neuroscience Center Speaker Disclosures: I have no relevant commercial relationships to disclose We guarantee that by the end of this lecture, each and every one of you will be able to differentiate between the benign and malignant causes of dizziness and near syncope... 1
2 Most of the time Dizziness Vertigo Lightheaded Near Syncope Syncope Decrease Balance Disequilibrium Almost 50% of the time no further history is obtained in the E.R. 2
3 Precipitating Factors: Position when episode occurred Prior vomiting or diarrhea Tinnitus Hearing deficit Differential Diagnosis: Cerebral Hypoperfusion Peripheral Lesion Central Lesion Cerebral Hypoperfusion: Arrythmias Aortic Stenosis Orthostatic Hypotension 3
4 Peripheral Lesion: BPPV Meniere s Central Lesion: Ischemic-VBI Mass Lesion DO NOT MISS Stroke Tumor Cardiac 4
5 Cost: Dizziness as presenting symptom in E.R $3.9 billion 2015 $4.4 billion ER E.R. visits million million A 97% increase Johns Hopkins We can save an estimated $1 billion by cutting out indiscriminate use of Cat Scans (CTs) Cat Scan miss almost 80% of strokes in the early stages Imaging tests on dizziness as presenting symptom has quadrupled since 1995 Johns Hopkins No real reliable, validated protocols for dizziness 5
6 Take Syncope Predictors: San Francisco Syncope Rules Boston Syncope Rules San Francisco Syncope Rules: History of CHF Hematocrit less than 30% EKG abnormalities SOB Systolic BP less than 90mm hg at triage 2-5% negative predictive value Ann Emergency Med 11/05 J Quinn Boston Syncope Rules: CP, SOB ABN EKG Worrisome cardiac hx Family Hx of sudden death Significant heart murmur Signs of conduction disease Volume depletion Persistent abnormal vs Primary CNS event 1% negative predictive value J emergency Med 10/07 S Grossman 6
7 With syncope, the cause is identified 48.3% of time Postural BP changes has a 58.7% yield History taken has a 19.7% yield Only 1.7% of money spent effectively Southern Ned Journal 11/14 P Johnson Evaluation of Dizziness: History Orthostatic blood pressure Physical exam Orthostatic Hypotension: Defined as a drop in systolic BP 20mm hg or more Drop in diastolic BP 10mm hg or more within 3 minutes of standing Arch Int Med 1992 Streeten & Anderson 7
8 DOH Delayed Orthostatic Hypotension: Orthostatic hypotension after 3 minutes DOH will progress to oh over time Similar disease mechanisms Similar long term complications Neurology 2015 C Gibbons, R Freeman Physical Exam: Look at the eyes Horizontal head impulse test Dix-hallpike maneuvers 8
9 Horizontal Head Impulse Test: Ask the patient to focus on a spot on the wall as clinician moves the patient's head from side to side. The clinician focuses their attention on the patient's eyes. If the patient is making fast, corrective eye adjustments in response to the head movements, that would indicate the patient experiencing a benign form of dizziness rather than a stroke D Newman-Toker, MD Johns Hopkins iphone App: SLOW MO $0.99 9
10 Dix-Hallpike Maneuver: Patient sits on exam table. Clinician turns patient s head degrees to one side and quickly tilts patient back with head hanging 20 degrees over the end of the exam table. Repeat procedure with head turned to the other side. If no vertigo or nystagmus, bpv less likely 5-10 second latency rotatory nystagmus, likely positive for BPV Fast phase of rotatory nystagmus is toward the affected ear (ear closest to the ground) Proc Royal Soc Med 1952 Dix, Hallpike Evidence-based Efficient Cost Effective vs. Risk Litigation Baptist Rules for Dizziness/Vertigo: Sx for at lest 72 hours No history of prior stroke No history of cancer No cardiac history or symptoms Normal neurological exam Orthostatic hypotension Positive hallpike Normal labs - CBC, Chem profile 10
11 Questions Comments Complaints 11
An Introduction to Dizziness and Vertigo
An Introduction to Dizziness and Vertigo Tamara Mijovic MD CM FRCSC Clinical Assistant Professor Department of Otolaryngology Head and Neck Surgery Otology, Neurotology & Skull Base Surgery McGill University
More informationPhysical Therapy Examination of the Acutely Vertiginous Patient. Objectives. Prevalence/Incidence of Dizziness 3/20/2018
Physical Therapy Examination of the Acutely Vertiginous Patient Andrew Wagner, PT, DPT, NCS Jennifer Williams, PT, DPT, NCS April 13, 2018 Objectives The learner will integrate basic examination principles
More informationDizziness: Neurological Aspect
Dizziness: Neurological Aspect..! E-mail: somtia@kku.ac.th http://epilepsy.kku.ac.th Features between peripheral and central vertigo 1. Peripheral Central 2.! " # $ " Imbalance Mild-moderate Severe 3.!
More informationThe Big 3 of Vertigo
They feel it, you see it, few know it: Common vertigo conditions seen, but rarely diagnosed Peter Johns MD, FRCPC University of Ottawa pjohns@toh.ca Twitter @peterjohns84 The Big 3 of Vertigo BPPV Vestibular
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 04/26/2014 Radiology Quiz of the Week # 108 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More informationEvaluation of the Dizzy Patient
Evaluation of the Dizzy Patient S. Andrew Josephson, MD Department of Neurology University of California San Francisco October 1, 2007 Who Sees Dizzy Patients? ED physicians Internists Neurologists ENT
More informationThe Geriatric Patient The EM Perspective. Advice from a neophyte
The Geriatric Patient The EM Perspective Advice from a neophyte Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any
More informationAcute Vestibular Syndrome (AVS) 12/5/2017
Sharon Hartman Polensek, MD, PhD Dept of Neurology, Emory University Atlanta VA Medical Center DIAGNOSTIC GROUPS FOR PATIENTS PRESENTING WITH DIZZINESS TO EMERGENCY DEPARTMENTS Infectious 2.9% Genitourinary
More informationVertigo. Definition Important history questions Examination Common vertigo cases and management Summary
Vertigo Vertigo Definition Important history questions Examination Common vertigo cases and management Summary Cases 1) 46 year old man presents two weeks after knocking his head with recurrent episodes
More informationBecause dizziness is an imprecise term, a major role of the clinician is to sort patients out into categories
Dizziness and Imbalance Timothy C. Hain, MD Clinical Professor of Neurology, Otolaryngology, Physical Therapy Chicago Dizziness and Hearing 645 N. Michigan, Suite 410 312-274-0197 Lecture Goals 1. What
More informationBPPV and Pitfalls in its Management. Reza Golrokhian Sani MD, Otolaryngologist- Head & Neck Surgeon Otologist & Neurotologist
BPPV and Pitfalls in its Management Reza Golrokhian Sani MD, Otolaryngologist- Head & Neck Surgeon Otologist & Neurotologist Objectives 1-The best methods of diagnosis of BPV 2-How to differentiate between
More informationVertigo. Definition. Causes. (Dizziness) Benign Paroxysmal Positional Vertigo (BPPV) Labyrinthitis. by Karen Schroeder, MS, RD
Vertigo (Dizziness) by Karen Schroeder, MS, RD En Español (Spanish Version) Definition Vertigo is a feeling of spinning or whirling when you are not moving. It can also be an exaggerated feeling of motion
More informationSasan Dabiri, MD, Assistant Professor
Sasan Dabiri, MD, Assistant Professor Department of Otorhinolaryngology Head & Neck Surgery Amir A lam hospital Tehran University of Medical Sciences October 2015 Outlines Anatomy of Vestibular System
More informationVestibular Symptoms in Concussion: Medical/Surgical Perspective. Jacob R. Brodsky, MD Boston Children s Hospital
Vestibular Symptoms in Concussion: Medical/Surgical Perspective Jacob R. Brodsky, MD Boston Children s Hospital jacob.brodsky@childrens.harvard.edu On Field Symptoms Headache Dizziness Confusion Fatigue
More informationWhat could be reffered to as dizziness by the patient?
What could be reffered to as dizziness by the patient? Rotational vertigo Sense of instability Ataxia of gait Disturbance of vision Loss of contact with surroundings Nausea Loss of memory Loss of confidence
More informationControl of eye movement
Control of eye movement Third Nerve Palsy Eye down and out Trochlear Nerve Palsy Note: Right eye Instead of intorsion and depression action of superior oblique See extorsion and elevation Observe how
More informationVertigo. David Clark, DO Oregon Neurology Associates Springfield, OR
Vertigo David Clark, DO Oregon Neurology Associates Springfield, OR 44F vertigo, nausea & vomiting Unidirectional Nystagmus 44F vertigo, nausea & vomiting Impaired VOR Gain to the right Vertigo History
More informationAcoustic neuroma s/p removal BPPV (Crystals)- 50% of people over 65 y/ o with dizziness will have this as main reason for dizziness
Dizziness and the Heart Mended Hearts Inservice Karen Hansen, PT, DPT, Cert Vestibular Rehab, CEAS Tennessee Therapy & Balance Center, LLC July 21, 2016 Balance We maintain balance with input from our
More informationVertigo. Tunde Magyar MD, PhD
Vertigo Tunde Magyar MD, PhD What could be reffered to as dizziness by the patient? Rotational vertigo Sense of instability Ataxia of gait Disturbance of vision Loss of contact with surroundings Nausea
More informationDeath after Syncope: Can we predict it? Daniel Zamarripa, MD Senior Medical Director December 2013
Death after Syncope: Can we predict it? Daniel Zamarripa, MD Senior Medical Director December 2013 Death after Syncope: Can we predict it? Those who suffer from frequent and severe fainting often die suddenly
More informationStroke Awareness. Presented by: Duane Anderson, MD Snoqualmie Valley Hospital Emergency Department Medical Director
Stroke Awareness Presented by: Duane Anderson, MD Snoqualmie Valley Hospital Emergency Department Medical Director What is a stroke? Stroke can happen to anyone. Stroke is the fourth leading cause of death
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationFunctional Limitation Reporting. Case Report on PQRS and G-Code reporting
Functional Limitation Reporting Case Report on PQRS and G-Code reporting Patient Demographics! 66 year old male referred by Dr. Schriefer, a neurologist, for PT evaluation and treatment! Chief Complaint:
More informationDifficult Diagnosis: An Interactive Session
Difficult Diagnosis: An Interactive Session W A D E S M I T H, M. D. D E P T. O F N E U R O L O G Y, U C S F F E B R U A R Y 1 5, 2 0 1 3 58-year-old man with HTN and HLD Recurrent episodes of dizziness
More informationDizziness Cases. Martin A. Samuels Chair, Department of Neurology Brigham and Women s Hospital Boston
Dizziness Cases Martin A. Samuels Chair, Department of Neurology Brigham and Women s Hospital Boston Basic Principles Take an open ended history Know the synonyms for dizziness A patient can have more
More informationClinical Evaluation & Management of Syncope:UPDATE
Clinical Evaluation & Management of Syncope:UPDATE 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope Developed in Collaboration with the American College of Emergency
More informationDepartment of Paediatrics Clinical Guideline. Syncope Guideline
Department of Paediatrics Clinical Guideline Syncope Guideline Definition Transient, self-limited loss of consciousness (TLOC), usually leading to falling. Onset is relatively rapid. Recovery is spontaneous,
More informationI m Weak and Dizzy. Dr. Peter J. Lin Director Primary Care Initiative Canadian Heart Research Centre
I m Weak and Dizzy Dr. Peter J. Lin Director Primary Care Initiative Canadian Heart Research Centre Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied,
More informationDizziness 101 E-Class TAKE HOME POINTS
Dizziness 101 E-Class Dizziness is one of the most common reasons people seek medical care Important to consider the inner ear as a cause 5.5: Average number of providers seen if the inner ear wasn t considered
More informationClinical Recommendation: Assessment and Management of Dizziness Associated with Mild TBI
Clinical Recommendation: Assessment and Management of Dizziness Associated with Mild TBI Learning Objectives Understand an overview of dizziness response following mild TBI Differentiate between three
More informationDifferential Diagnosis: Vestibular Pathology. Causes of Dizziness. Benign Paroxysmal Positional Vertigo
Differential Diagnosis: Vestibular Learning objective: The participant will identify the pathologies associated with complaints of imbalance and dizziness Anne K Galgon PT, PhD, NCS Vestibular and Related
More informationBenign Paroxysmal Positional Vertigo
Benign Paroxysmal Positional Vertigo Information for patients and families Read this booklet to learn about: What Benign Paroxysmal Positional Vertigo (BPPV) is Symptoms How your doctor will diagnose it
More informationChapter 19 Dizziness and Vertigo
Chapter 19 Dizziness and Vertigo Episode overview: 1) Compare characteristics of peripheral and central vertigo 2) What are risk factors for central causes of vertigo? 3) List 4 vestibulotoxic drugs. 4)
More informationOHSU HEALTH CARE SYSTEM PRACTICE GUIDELINES
OHSU HEALTH CARE SYSTEM NEUROSCIENCES (includes ischemic stroke, TIA, intracerebral hemorrhage and non-subarachnoid hemorrhage) Last Reviewed Date: September 2013 POLICY STATEMENT: OHSU hospitals and clinics
More informationHypertension The normal radial artery blood pressures in adults are: Systolic arterial pressure: 100 to 140 mmhg. Diastolic arterial pressure: 60 to
Hypertension The normal radial artery blood pressures in adults are: Systolic arterial pressure: 100 to 140 mmhg. Diastolic arterial pressure: 60 to 90 mmhg. These pressures are called Normal blood pressure
More informationDIZZINESS & VERTIGO A MULTIDISCIPLINARY APPROACH
DIZZINESS & VERTIGO A MULTIDISCIPLINARY APPROACH Dr DOSH SANDOORAM MB ChB, MD, FRCS Consultant ENT Surgeon, City Clinic Group Labyrinthine disturbance may make one feel like the end of the world has arrived...
More informationPractical Emergency Medicine Dizziness and vertigo. Dr. H K Tong Consultant A&E Dept Queen Mary Hospital Hon Associate Prof. HKU
Practical Emergency Medicine Dizziness and vertigo Dr. H K Tong Consultant A&E Dept Queen Mary Hospital Hon Associate Prof. HKU Introduction Dizziness Common And Challenging: Too many possible diagnoses
More informationYou Spin Me Right Round: A Neurologist s Approach to Dizziness & Vertigo Peter Hannon, MD
Slide 1 You Spin Me Right Round A Neurologist s Approach to Dizziness & Vertigo https://www.youtube.com/watch?v=pgnixgx2nlu Slide 2 Disclosures None Can t help tapping my feet to 80s glam rock I tweak
More informationCITY & HACKNEY PATHFINDER CLINICAL COMMISSIONING GROUP. Vertigo. (1) Vertigo. (4) Provisional Diagnosis. (5) Investigations. lasting days or weeks
Authors: Dr Lucy O'Rouke and Mr N Eynon-Lewis Review date: January 2017 Vertigo (1) Vertigo (2) History (3) Examination (4) Provisional Diagnosis (5) Investigations (6) Medical Cause (7) Psychiatric Cause
More informationwhat is the permanent impact of loss of the vestibular sense? for balance, vision and spatial orientation)
what is the permanent impact of loss of the vestibular sense? for balance, vision and spatial orientation) loss of speed - poor dynamic vision (daily life) - fear to fall and falls loss of automatisation
More informationSyncope Update Dr Matthew Lovell, Consultant in Cardiology
Syncope Update Dr Matthew Lovell, Consultant in Cardiology Definition of Syncope Syncope is defined as TLOC due to cerebral hypoperfusion Characterized by a rapid onset, short duration, and spontaneous
More informationVestibular System. BAA Conference 2014 Assistant Audiologist Workshop
Vestibular System BAA Conference 2014 Assistant Audiologist Workshop Balance testing - why do we do it? Dizziness / vertigo / unsteadiness / light-headedness Very common Very distressing Nausea / vomiting
More informationQuarterly Collaborative Call #24 April 18, :00 2:30 p.m. CST. Critical Thinking: (R) CVA AND Orthostatic Hypotension as Fall Risk Factors
Quarterly Collaborative Call #24 April 18, 2017 2:00 2:30 p.m. CST Critical Thinking: (R) CVA AND Orthostatic Hypotension as Fall Risk Factors 1. Housekeeping Quarterly Calls AGENDA 2. KNOW Falls Debrief
More informationThe San Francisco Syncope Rule to Predict Patients with Serious Outcomes
The San Francisco Syncope Rule to Predict Patients with Serious Outcomes Daniel McDermott, MD Associate Clinical Professor Department of Emergency Medicine University of California, San Francisco An Interesting
More informationVertigo: A practical approach to diagnosis and treatment. John Waterston
Vertigo: A practical approach to diagnosis and treatment John Waterston Background. Vertigo is a symptom that has diverse causes. The diagnosis may remain elusive even after exhaustive clinical enquiry
More informationSyncope : What tests should I do? Boon Lim Consultant Cardiologist Clinical Lead for Imperial Syncope Unit Hammersmith Hospital
Syncope : What tests should I do? Boon Lim Consultant Cardiologist Clinical Lead for Imperial Syncope Unit Hammersmith Hospital The most important diagnostic test is History taking Why is history taking
More informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST The Management of Syncope remains a challenge: Clues from the History Richard Sutton, DSc Emeritus Professor of Cardiology Imperial College, St Mary s Hospital, London,
More informationV e r t i g o. T ü n d e. M a g y a r
V e r t i g o T ü n d e M a g y a r Dizziness Vestibular Proprioception Optic input (afferentation) carries not Optic input (afferentation) carries not synchronizated information to the CNS, but contradictory
More informationANTERIOR CANAL BPPV and its controversies. Marco Mandalà
ANTERIOR CANAL BPPV and its controversies. Marco Mandalà Otology and Skull Base Surgery Department University of Siena, Italy AC-BPPV HISTORY (vs PC) AC-BPPV PC-BPPV 1921, Barany first description 1952,
More informationDizziness is VERY Common. Dizziness is an imprecise term. Diagnostic Categories. Question. Answer 1. The Dizzy Patient Recent advances (2007)
The Dizzy Patient Recent advances (2007) Timothy C. Hain, MD Chicago Dizziness and Hearing Neurology, Otolaryngology, Physical Therapy Northwestern University, Chicago t-hain@northwestern.edu Dizziness
More informationWhat Do You Think of My Posterior?
What Do You Think of My Posterior? Posterior Stroke and Stroke Mimics Peter Panagos, MD, FACEP, FAHA Associate Professor Emergency Medicine and Neurology Washington University School of Medicine Disclosures
More informationCardiac Pathophysiology
Cardiac Pathophysiology Evaluation Components Medical history Physical examination Routine laboratory tests Optional tests Medical History Duration and classification of hypertension. Patient history of
More informationSyncope Cardiac or not? Dr Jaycen Cruickshank Emergency Physician Director of Clinical Training BHS
Syncope Cardiac or not? Dr Jaycen Cruickshank Emergency Physician Director of Clinical Training BHS Syncope( (cardiac(or(not?( What(is(syncope?( Syncope( is( a( brief( loss( of( consciousness( that( resolves(
More informationBenign paroxysmal positional vertigo: clinical characteristics of dizzy patients referred to a Falls and Syncope Unit
Q J Med 2005; 98:357 364 Advance Access publication 8 April 2005 doi:10.1093/qjmed/hci057 Benign paroxysmal positional vertigo: clinical characteristics of dizzy patients referred to a Falls and Syncope
More informationDisclosures. Goals. Canalith Repositioning Basics to Advanced. John Li, M.D. We have no conflicts of interest to disclose.
Canalith Repositioning Basics to Advanced John Li, M.D. Disclosures We have no conflicts of interest to disclose. Goals Beginner to Epert 2 hrs into 1 Definition, History, Physical, Diagnosis, Treatment
More informationFaculty Disclosure. Sanjay P. Singh, MD, FAAN. Dr. Singh has listed an affiliation with: Consultant Sun Pharma Speaker s Bureau Lundbeck, Sunovion
Faculty Disclosure Sanjay P. Singh, MD, FAAN Dr. Singh has listed an affiliation with: Consultant Sun Pharma Speaker s Bureau Lundbeck, Sunovion however, no conflict of interest exists for this conference.
More informationAdequacy of Initial History and Physical Examination
October 13 th 2015 I am an Associate Professor in the Department of Emergency Medicine, University of Ottawa. I have expertise in Emergency Medicine and hold a certificate of special competency with the
More informationDizziness, postural hypotension and postural blackouts: Two cases suggesting multiple system atrophy
Dizziness, postural hypotension and postural blackouts: Two cases suggesting multiple system atrophy Dr Rahul Chakor, Associate Prof and Head Dept of Neurology, Dr Anand Soni, Senior Resident, T N Medical
More informationOBJECTIVES TYPES OF DIZZINESS TYPES OF DIZZINESS. Type III Disequilibrium. Classifying Common Position Sense Disturbances
OBJECTIVES Define four major types of dizziness Emphasizing vertigo Describe pathophysiology of dizziness Emphasizing BPPV Review how to cure BPPV How do you know where you are in 3-dimensional space?
More informationUsage of the HINTS exam and neuroimaging in the assessment of peripheral vertigo in the emergency department
Quimby et al. Journal of Otolaryngology - Head and Neck Surgery (2018) 47:54 https://doi.org/10.1186/s40463-018-0305-8 ORIGINAL RESEARCH ARTICLE Open Access Usage of the HINTS exam and neuroimaging in
More informationBenign Paroxysmal Positional Vertigo (a.k.a.) Diagnosis: Dix-Hallpike Maneuver. Case SH. BPPV nystagmus. Video Frenzel Goggles make it easier
Positional Vertigo Office Diagnosis and Treatment Timothy C. Hain, MD Departments of Neurology, Otolaryngology and Physical Therapy Northwestern University, Chicago, IL Janet O. Helminski, PhD Physical
More informationVERTIGO. Tuesday 20 th February 2018 Dr Rukhsana Hussain. Disclaimers apply:
VERTIGO Tuesday 20 th February 2018 Dr Rukhsana Hussain WHAT IS VERTIGO? 4 Vertigo is defined as an illusory sensation of motion of either the self or the surroundings in the absence of true motion. Explaining
More informationSyncope Guidelines What s new? October 19 th 2017 Mohamed Aljaabari MBBCh, FACC, FHRS Consultant Electrophysiologist - Mafraq Hospital
Syncope Guidelines What s new? October 19 th 2017 Mohamed Aljaabari MBBCh, FACC, FHRS Consultant Electrophysiologist - Mafraq Hospital Case Presentation 35 Male presented with sudden loss of consciousness
More informationWorkshop: The Assessment of Patients with Dizziness and Vertigo
Workshop: The Assessment of Patients with Dizziness and Vertigo Tamara Mijovic MD CM FRCSC Clinical Assistant Professor Department of Otolaryngology Head and Neck Surgery Otology, Neurotology & Skull Base
More informationSYNCOPE. Sanjay P. Singh, MD Chairman & Professor, Department of Neurology. Syncope
SYNCOPE Sanjay P. Singh, MD Chairman & Professor, Department of Neurology. Syncope Syncope is a clinical syndrome characterized by transient loss of consciousness (TLOC) and postural tone that is most
More informationBY: Ramon Medina EMT-LP/RN
BY: Ramon Medina EMT-LP/RN Discuss types of strokes Discuss the physical and neurological assessment of stroke patients Discuss pertinent historical findings Discuss pre-hospital and emergency management
More informationLA CLINICA E LA DIAGNOSI DELLA VERTIGINE VASCOLARE
LA CLINICA E LA DIAGNOSI DELLA VERTIGINE VASCOLARE M. Mandalà Azienda Ospedaliera Universitaria Senese WHY ARE WE SCARED? NEED TO BETTER UNDERSTAND PATHOPHYSIOLOGY WHAT IS KNOWN WHAT IS EFFECTIVE and SIMPLE
More informationPredictors of Protracted Recovery
CONCUSSION MANAGEMENT SPECIALIST ON LINE CURRICULUM Protracted Recovery and Clinical Rehabilitation All rights reserved. Sports Medicine Concepts Concussion Management Specialist Program 1 Predictors of
More informationBenign Paroxysmal Positional Vertigo. Jeff Walter PT, DPT, NCS
Benign Paroxysmal Positional Vertigo Jeff Walter PT, DPT, NCS Benign Paroxysmal Positional Vertigo: (BPPV) Benign = not malignant Paroxysmal = recurrent, sudden intensification of symptoms Positional =
More informationMedicine Dr. Aso Lecture 9 Syncope and Pre-syncope
Medicine Dr. Aso Lecture 9 Syncope and Pre-syncope SYNCOPE AND PRE-SYNCOPE Syncope:- sudden, transient loss of consciousness, due to reduced cerebral perfusion. The patient is unresponsive with loss of
More information2/8/2017 WHERE ARE WE? East Amherst East Aurora Hamburg West Seneca Williamsville Boulevard
2/8/2017 WHERE ARE WE? East Amherst East Aurora Hamburg West Seneca Williamsville Boulevard 1 2/8/2017 MY GOAL TODAY. 1. Provide a quick overview on falls 2. How our balance systems work 3. What treatments
More informationI m dizzy-what can I expect at my doctor visit? Dennis M. Moore, M.D. Lutheral General
I m dizzy-what can I expect at my doctor visit? Dennis M. Moore, M.D. Lutheral General Dizziness and Balance is a broad area encompassing multiple fields: primary care (internal medicine, pediatrics),
More informationInternational Journal of Medical and Exercise Science (Multidisciplinary, Peer Reviewed and Indexed Journal)
ORIGINAL ARTICLE International Journal of Medical and Exercise Science (Multidisciplinary, Peer Reviewed and Indexed Journal) PHYSICAL THERAPY MANAGEMENT IN PATIENTS WITH CERVICOGENIC DIZZINESS-A CASE
More informationSyncope Guidelines: What s New?
Syncope Guidelines: What s New? Dr. Samuel Asirvatham Professor of Medicine and Pediatrics Mayo Clinic College of Medicine Medical Director, Electrophysiology Laboratory Program Director, EP Fellowship
More information11/1/2018. Disclosure. Imaging in Acute Ischemic Stroke 2018 Neuro Symposium. Is NCCT good enough? Keystone Heart Consultant, Stock Options
Disclosure Imaging in Acute Ischemic Stroke 2018 Neuro Symposium Keystone Heart Consultant, Stock Options Kevin Abrams, M.D. Chief of Radiology Medical Director of Neuroradiology Baptist Hospital, Miami,
More informationDifficult Data Definitions and Scenario s
Difficult Data Definitions and Scenario s Presenter Disclosure Information Cornelia Anderson BSN, RN To following relationships exist related to this presentation: No Disclosures Objectives Discuss key
More informationVestibular Differential Diagnosis
Vestibular Differential Diagnosis P R E S E N T E D B Y : S H A R I K I C K E R, P T, M P T C E R T I F I C A T E I N V E S T I B U L A R R E H A B I L I T A T I O N 2 0 1 7 L A C E Y H A L E, P T, D P
More informationImbalance, Dizziness & Vertigo. Monquen Huang, MD
Imbalance, Dizziness & Vertigo Monquen Huang, MD Summary Targeted History Directed Physical Exam Common Diagnosis & Treatment Sense of Balance From 3 organ systems Eyes Inner ears Joints and muscles Our
More informationOHSU Health Care System
Acute Stroke Practice Standard for the Emergency Department (includes ischemic stroke, TIAs, intracerebral hemorrhage, and non-subarachnoid hemorrhage), PS 01.11 Last Reviewed Date: 2/2/10 STATEMENT OF
More informationSYNCOPE SYNCOPE 5/1/2013. J. Scott Neumeister M. D. Nebraska Medical Center
SYNCOPE J. Scott Neumeister M. D. Nebraska Medical Center SYNCOPE Transient loss of consciousness Altered blood flow to the brain Quality Quantity Postural collapse European society of Cardiology. Guidelines
More informationUNIVERSITY HOSPITALS OF LEICESTER NHS TRUST CARDIAC INVESTIGATIONS PAEDIATRIC & CONGENITAL SYNCOPE INVESTIGATIONS/QUESTIONNAIRE PROTOCOL
UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST CARDIAC INVESTIGATIONS PAEDIATRIC & CONGENITAL SYNCOPE INVESTIGATIONS/QUESTIONNAIRE PROTOCOL Written Date: 2009 by Dr Duke, then updated by Dr Sarita Makam 12/4/2016
More informationDominic J Mort 23/03/17 Spire Bushey Hospital
Dominic J Mort 23/03/17 Spire Bushey Hospital Dizziness Good grief! Hx: Pre-syncope Dizziness As if you might faint? Vertigo Mostly about this As if on a merry-go-round? Non-rotational commoner than spinning
More informationLecture Goals. Dizziness is VERY Common. Dizziness is an imprecise term. Question 1. Diagnostic Categories
Otoneurologist Approach to the Dizzy Patient Timothy C. Hain, MD Clinical Professor Neurology, Otolaryngology, Physical Therapy Northwestern University, Chicago t-hain@northwestern.edu Lecture Goals Describe
More informationThe evaluation of a patient with dizziness
The evaluation of a patient with dizziness Kevin A. Kerber and Robert W. Baloh Neurol Clin Pract 2011;1;24 DOI 10.1212/CPJ.0b013e31823d07b6 This information is current as of December 28, 2011 The online
More informationClinical Studies 129
Clinical Studies 129 Syncope in migraine. The population-based CAMERA study Roland D. Thijs, 1* Mark C. Kruit, 2* Mark A. van Buchem, 2 Michel D. Ferrari, 1 Lenore J. Launer, 3,4 and J. Gert van Dijk
More informationDizziness, Vertigo, and Syncope: Assessment and treatment
Dizziness, Vertigo, and Syncope: Assessment and treatment Sally K. Miller, PhD, APRN FNP-BC, AGACNP-BC, AGPCNP-BC Associate Professor University of Nevada Las Vegas School of Nursing Nurse Practitioner
More informationBenign Paroxysmal Positional Vertigo (a.k.a.) Diagnosis: Dix-Hallpike Maneuver. Case SH. BPPV nystagmus. Video Frenzel Goggles make it easier
Canalith Repositioning for Benign Paroxysmal Positional Vertigo Benign Paroxysmal Positional Vertigo (a.k.a.) Timothy C. Hain, MD Departments of Neurology, Otolaryngology and Physical Therapy Northwestern
More informationBenign paroxysmal positional. Labyrinth. Canalolithiasis. Specialized dizzy clinic - most frequent diagnoses. Semicircular canals
Specialized dizzy clinic - most frequent diagnoses Canalolithiasis Unclear vertigo/dizziness multisensory vertigo/dizziness Benign paroxysmal positional vertigo (BPPV) hands on unilateral vestibulopathy
More informationEMU 2017 DIZZINESS AND VERTIGO Walter Himmel MD
EMU 2017 DIZZINESS AND VERTIGO Walter Himmel MD There is only one essential challenge in the world of dizziness and vertigo: Don t miss a posterior circulation stroke (vertebral/basilar artery) or TIA.
More informationOBJECTIVES BALANCE EVALUATION COMMON CAUSES OF BALANCE DEFICITS POST TBI BRAIN INJURY BALANCE RELATIONSHIP
OBJECTIVES Understand variables that contribute to balance deficits Understand the relationship between a brain injury and balance Become familiar with the components of a vestibular/balance assessment
More informationQuick Guides Vestibular Diagnosis and Treatment:
VNG - Balance Testing Quick Guides Vestibular Diagnosis and Treatment: A Physical Therapy Approach Dix-Hallpike Test for Diagnosis of BPPV Epley Canalith Repositioning Procedure (CRP) Semont Maneuver for
More informationThe Clinical Differentiation of Cerebellar Infarction from Common Vertigo Syndromes
REVIEW ARTICLE The Clinical Differentiation of from Common Vertigo Syndromes James A. Nelson, MD* Erik Viirre MD, PhD * University of California at San Diego, Department of Emergency Medicine University
More informationManagement Of Medical Emergencies
Management Of Medical Emergencies U.S. Aging Population 35 million people (12%) 65 years or older Number will increase by nearly 75% by year 2030 The number of people more than 85 years old will approach
More informationSyncope By Remus Popa
Syncope By Remus Popa A 66 years old male is brought to the ED from a restaurant where he fainted while dining out with his family. He complained of nausea and stood up to go to the restroom but immediately
More informationProtocol for IV rtpa Treatment of Acute Ischemic Stroke
Protocol for IV rtpa Treatment of Acute Ischemic Stroke Acute stroke management is progressing very rapidly. Our team offers several options for acute stroke therapy, including endovascular therapy and
More informationIt s Always a Stroke; Except For When It s Not..
It s Always a Stroke; Except For When It s Not.. TREVOR PHINNEY, D.O. Disclosures No Relevant Disclosures 1 Objectives Discuss variables of differential diagnosis for stroke Review when to TPA and when
More informationManaging Acute Vertigo for the Non-Vestibular PT. Objectives 4/12/2018
Managing Acute Vertigo for the Non-Vestibular PT Dalerie Lieberz, PT, DPT, GCS Assistant Professor and DCE at The College of St. Scholastica & staff therapist with the Balance & Dizziness Center at Essentia
More informationSevere Hypertension. Pre-referral considerations: 1. BP of arm and Leg 2. Ambulatory BP 3. Renal causes
Severe Hypertension *Prior to making a referral, call office or Doc Halo, to speak with a Cardiologist or APP to discuss patient and possible treatment options. Please only contact the patient's cardiologist.
More informationBenign Paroxysmal Positional Vertigo (BPPV) Structures of importance. The ear is an inertial navigation device. Vestibular Reflexes
Otologic Dizziness (Dizziness from Ear) Structures of importance Timothy C. Hain, MD Northwestern University, Chicago t-hain@northwestern.edu The ear is an inertial navigation device Semicircular Canals
More informationCardiology. the Sounds: #7 HCM. LV Outflow Obstruction: Aortic Stenosis. (Coming Soon - HCM)
A Cardiology HCM LV Outflow Obstruction: Aortic Stenosis (Coming Soon - HCM) the Sounds: #7 Howard J. Sachs, MD www.12daysinmarch.com E-mail: Howard@12daysinmarch.com Aortic Valve Disorders Stenosis Regurgitation
More information