clumsiness of arms, or legs), gait unsteadiness, and vertigo. Cerebellar stroke: Symptoms can include dysarthria, dysphagia, dysmetria (limb ataxia e.g.Main therapy is early return to activity, +/- vestibular exercises, or vestibular rehab/physical therapy. Limit use of benzodiazepines, and meclizine to 3 days. It’s called labrynthitis if associated hearing loss). Dizziness/vertigo is accompanied by nausea or vomiting, unsteady gait, nystagmus and intolerance to head motion. Vestibular neuritis: Acute, benign, self-limited condition presumed to be viral or postviral.Chronic therapy can include low salt diet, or ablative procedure like intratympanic gentamicin. Meclizine is reasonable choice if limited to 3 days. Usually lasts hours with range 20 minutes to a few days (West J Emerg Med 2009). Similar to vestibular neuritis, but transient. hearing loss, tinnitus, or aural fullness. Meniere’s disease: Simultaneous vertigo and cochlear complaints e.g.headache, photophobia, or aura) and 4) the exclusion of other causes (West J Emerg Med 2009). Strict criteria require: 1) recurrent episodes of vertigo 2) a formal migraine diagnosis by International Headache Society criteria 3) a migraine symptom during the attack (e.g. Vestibular migraine: Usually episodic, spontaneous symptoms for many years.Treatment is similar to Epley, but patient’s head rests on a pillow (rather than hanging from edge of bed) as repositioning maneuver is performed Lempert roll maneuver (see figure 5 in this link). Diagnose with supine roll test (click here to see video). Symptoms triggered by horizontal or rotational movements of the head e.g. Treat with Epley maneuver (click here to see video). Diagnose with Dix-Hallpike (specific for posterior canal BPPV). Symptoms triggered by “pitch-plane” movements. Posterior canal BPPV: Most common type.Some patients have an “anxiety” component w/o underlying pathology (diagnosis of exclusion). If insidious onset, then suspect an underlying primary neurologic disorder. Many patients had a previous acute vestibular syndrome and never fully recovered. Chronic vestibular syndrome: Symptoms of vertigo lasting one month or more.Differential diagnosis = vestibular neuritis (aka labrynthitis if associated hearing loss) versus stroke. Acute vestibular syndrome: Persistent vertiginous symptoms 12 hours or more.NOT triggered), then transient ischemic attack must be considered! Differential diagnosis = benign paroxysmal, positional vertigo (BPPV), vestibular migraine, and Meniere’s disease. Episodic vestibular syndrome: Acute vertiginous symptoms present for under 12 hours (usually seconds or minutes).Buckets: episodic, acute, or chronic vestibular syndromes (see below for detailed description).All patients with vertigo will feel worse with head movements! The KEY distinction is whether the head movements TRIGGER vertigo (suggestive of episode vestibular syndrome), or EXACERBATE vertigo in a patient w/continuous ongoing vertiginous symptoms (suggestive of acute vestibular syndrome).These inform the appropriate choice of physical exam maneuvers e.g. timing of dizziness, and what triggers the dizziness. Focus on timing, triggers, and targeted exam i.e. vertigo, presyncope, unsteadiness, non-specific other type of dizziness. Classification of dizziness: Don’t focus on type e.g.Literally! It runs in the background so patients are usually unaware of it, and thus have difficulty describing the sensation of dizziness. Vestibular system: It’s the 6th sense.Ĭase: A 45-year-old man presents to the emergency department because of continuous dizziness, nausea, vomiting and unsteady gait that began 18 hours earlier. Rate us on iTunes, recommend a guest or topic and give feedback at. Cyrus Askin who found our expert, wrote the questions for this episode, and acted as our cohost.
#Meclizine for vertigo how to#
We learn how to differentiate stroke from other causes of dizziness/vertigo how to approach the differential diagnosis in dizziness/vertigo how to perform the Dix-Hallpike test, Epley maneuver, and HINTS exam plus, who benefits from medical therapy and vestibular rehab. David Newman-Toker, Professor of Neurology, Ophthalmology and Otolaryngology at Johns Hopkins University. A simplified approach to dizziness/vertigo with tips from international expert, Dr.
0 kommentar(er)
