BOOK
Emergency Neuro-Otology: Diagnosis and Management of Acute Dizziness and Vertigo, An Issue of Neurologic Clinics, E-Book
(2015)
Additional Information
Book Details
Abstract
The focus of this publication on Neuro-Otology in Neurologic Clinics is on the patient presenting for urgent or emergent care with a chief complaint of new, previously-undiagnosed dizziness or vertigo. Intent is to emphasize throughout the issue five primary components of initial diagnosis and management: (1) Epidemiology, differential diagnosis, and disease definitions; (2) Bedside clinical features that differentiate dangerous from benign causes; (3) Appropriate use of advanced diagnostic tests (including imaging, vestibular tests) and consultations; (4) Application of early treatments (manipulative, pharmacologic, rehabilitative); and (5) Acute disposition strategies, including determining need for admission and urgency of follow-up. Articles have a consistent architecture to highlight key points: 1) Case Scenario (with a representative case example; videos are presented with many of these); 2) Prevalence & Pathomechanisms; 3) Definitions & Diagnostic Criteria; 4) Bedside & Laboratory Diagnostic Tests; 5) Acute Treatment Options (including manipulative, pharmacologic, rehabilitative); and 6) Triage & Disposition (including referrals and follow-up). The articles are presented with four major parts: Overall approach to acute dizziness and vertigo; Episodic vertigo and dizziness; Acute, continuous vertigo and dizziness; and Case unknowns. Among the topics covered are: Bedside evaluation; Transient ischemic attacks; Vestibularl neuritis and labyrinthitis; Stroke; Novel approach to diagnosing the acutely dizzy patient. David Newman-Toker leads this publication with associate editors renown in their fields - Kevin Kerber, William J. Meurer, Rodney Omron, and Jonathan Edlow.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Emergency Neuro-Otology: Diagnosis and Management of Acute Dizziness and Vertigo\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Forthcoming Issues | xii | ||
| Preface\r | xiii | ||
| Overview of the International Classification of Vestibular Disorders | 541 | ||
| Key points | 541 | ||
| Introduction | 541 | ||
| Goals and scope for the International Classification of Vestibular Disorders initiative | 542 | ||
| Methodology and process for developing the International Classification of Vestibular Disorders | 543 | ||
| International Classification of Vestibular Disorders structure | 545 | ||
| International Classification of Vestibular Disorders layer I: symptoms and signs | 545 | ||
| International Classification of Vestibular Disorders layer II: syndromes | 546 | ||
| International Classification of Vestibular Disorders layer III: disorders and diseases | 547 | ||
| International Classification of Vestibular Disorders layer III-B: mechanisms | 548 | ||
| International Classification of Vestibular Disorders and functional outcomes | 548 | ||
| Summary | 549 | ||
| Acknowledgment | 549 | ||
| References | 549 | ||
| Bedside Assessment of Acute Dizziness and Vertigo | 551 | ||
| Key points | 551 | ||
| Introduction | 552 | ||
| The history | 552 | ||
| Is It Truly Vertigo? | 552 | ||
| Is It the First Ever Attack or Is It Long-standing Recurrent Vertigo? | 552 | ||
| Is It Spontaneous or Positional? | 552 | ||
| What Is the Duration of Each Spell? | 553 | ||
| What Are the Associated Symptoms? | 553 | ||
| Do Recent Events Provide a Clue? | 553 | ||
| The physical examination | 553 | ||
| The General Inspection | 553 | ||
| Inspection for Spontaneous and Gaze-evoked Nystagmus | 554 | ||
| Provocative Testing for Positional Nystagmus | 555 | ||
| Head-shaking nystagmus | 558 | ||
| The Head Impulse | 559 | ||
| Oculomotor Examination | 560 | ||
| Test horizontal and vertical saccades | 560 | ||
| Test pursuit | 560 | ||
| Visual cancellation of the vestibulo-ocular reflex | 560 | ||
| Vestibulospinal Reflexes | 561 | ||
| General Neurologic Assessment | 561 | ||
| Postural Blood Pressure, Pulse, and Auscultation | 561 | ||
| What might be seen in a patient presenting with acute vestibular syndrome | 561 | ||
| Vestibular Neuritis | 561 | ||
| Cerebellar Stroke | 561 | ||
| What might be seen in episodic spontaneous vertigo | 562 | ||
| Meniere Disease | 562 | ||
| Vestibular Migraine | 562 | ||
| What might be seen in the patient with recurrent positional vertigo | 562 | ||
| Benign Positional Vertigo | 562 | ||
| When the patient is acutely dizzy and there are no physical signs to find | 563 | ||
| Future directions in acute vertigo | 563 | ||
| Supplementary data | 563 | ||
| References | 563 | ||
| Misdiagnosing Dizzy Patients | 565 | ||
| Key points | 565 | ||
| Introduction | 565 | ||
| Pitfall 1: overreliance on the type of dizziness to guide diagnostic inquiry | 566 | ||
| Pitfall 2: underuse and misuse of timing and triggers to categorize patients for diagnosis | 568 | ||
| Pitfall 3: underuse, misuse, and misconceptions linked to hallmark eye examination findings | 569 | ||
| Pitfall 4: overweighting age, vascular risk factors, and general neurologic examination to screen for stroke | 571 | ||
| Pitfall 5: overuse and overreliance on head computed tomography to rule out neurologic causes | 571 | ||
| Summary | 572 | ||
| Acknowledgments | 573 | ||
| References | 573 | ||
| TiTrATE | 577 | ||
| Key points | 577 | ||
| Introduction | 577 | ||
| New diagnostic approach | 578 | ||
| Four vestibular syndromes | 581 | ||
| Episodic Vestibular Syndrome | 581 | ||
| Triggered episodic vestibular syndrome | 581 | ||
| Approach | 581 | ||
| Diseases | 586 | ||
| Spontaneous episodic vestibular syndrome | 586 | ||
| Approach | 586 | ||
| Diseases | 587 | ||
| Acute Vestibular Syndrome | 588 | ||
| Traumatic/toxic acute vestibular syndrome | 588 | ||
| Approach | 588 | ||
| Diseases | 589 | ||
| Spontaneous acute vestibular syndrome | 589 | ||
| Approach | 589 | ||
| Diseases | 590 | ||
| Bedside approach summary | 591 | ||
| Summary | 591 | ||
| Acknowledgments | 591 | ||
| Appendix | 592 | ||
| References | 592 | ||
| Benign Paroxysmal Positional Vertigo in the Acute Care Setting | 601 | ||
| Key points | 601 | ||
| Case scenario | 601 | ||
| Epidemiology | 602 | ||
| Pathophysiology | 602 | ||
| Early Diagnosis and Management of Acute Vertigo from Vestibular Migraine and Ménière's Disease | 619 | ||
| Key points | 619 | ||
| Vestibular migraine | 619 | ||
| Case Scenario | 619 | ||
| Prevalence and Pathophysiologic Mechanisms | 620 | ||
| Neuroanatomic regions implicated | 620 | ||
| Definitions and Diagnostic Criteria (Differentiation from transient ischaemic attack [TIA] + Approach to Initial Diagnosis) | 621 | ||
| Bedside and Laboratory Diagnostic Tests | 621 | ||
| History | 621 | ||
| The examination | 623 | ||
| Laboratory test | 623 | ||
| Immediate Treatment Options | 623 | ||
| Triage and Disposition | 623 | ||
| Prophylaxis | 623 | ||
| Ménière’s disease | 623 | ||
| Case Scenario | 623 | ||
| Prevalence and Pathophysiologic Mechanisms | 624 | ||
| Definitions and Diagnostic Criteria (Differentiation from TIA + Approach to Initial Diagnosis) | 624 | ||
| Bedside and Laboratory Diagnostic Tests | 624 | ||
| Immediate Treatment Options (Including Manipulative and Pharmacologic [Rehabilitative]) | 625 | ||
| Triage and Disposition | 625 | ||
| When to refer | 626 | ||
| References | 626 | ||
| Transient Ischemic Attacks Presenting with Dizziness or Vertigo | 629 | ||
| Key points | 629 | ||
| Case scenario | 629 | ||
| Introduction | 630 | ||
| Prevalence and pathomechanisms | 631 | ||
| Definitions | 633 | ||
| Diagnostic approach: bedside and laboratory testing | 634 | ||
| History and Examination | 634 | ||
| Diagnostic Evaluation | 634 | ||
| Laboratory Tests | 636 | ||
| Acute treatment options | 636 | ||
| Blood Pressure | 636 | ||
| Medical Therapy | 637 | ||
| Antithrombotic medications | 637 | ||
| Statins | 637 | ||
| Revascularization | 637 | ||
| Triage and disposition | 638 | ||
| Summary | 639 | ||
| References | 639 | ||
| Medical and Psychiatric Causes of Episodic Vestibular Symptoms | 643 | ||
| Key points | 643 | ||
| Case scenario | 643 | ||
| Introduction | 644 | ||
| Definitions | 645 | ||
| Epidemiology | 645 | ||
| Bedside diagnosis | 645 | ||
| History | 646 | ||
| Physical Examination | 646 | ||
| Initial Management and Further Diagnostic Testing | 647 | ||
| Specific conditions that can cause episodic dizziness | 647 | ||
| Orthostatic Hypotension | 647 | ||
| Postural Tachycardia Syndrome | 648 | ||
| Syncope/presyncope (arrhythmia/neutrally mediated syncope) | 648 | ||
| Medication effects | 649 | ||
| Hypoglycemia and toxic/metabolic causes | 651 | ||
| Visual disorders | 651 | ||
| Cervical spondylosis | 651 | ||
| Panic attacks and anxiety disorders | 652 | ||
| Fibromyalgia | 653 | ||
| Hyperventilation | 653 | ||
| Summary | 656 | ||
| References | 656 | ||
| Early Diagnosis and Treatment of Traumatic Vestibulopathy and Postconcussive Dizziness | 661 | ||
| Key points | 661 | ||
| Introduction | 661 | ||
| The definition of mild traumatic brain injury | 662 | ||
| Epidemiology | 662 | ||
| Balance disorders after blast injuries | 663 | ||
| Balance disorders after blunt head injury | 664 | ||
| Diagnosis | 664 | ||
| Treatment | 665 | ||
| Summary | 666 | ||
| References | 666 | ||
| Acute Unilateral Vestibulopathy | 669 | ||
| Key points | 669 | ||
| Case scenario | 669 | ||
| Prevalence and pathomechanisms | 670 | ||
| Epidemiology | 670 | ||
| Etiology | 670 | ||
| Pathophysiology | 671 | ||
| Peripheral vestibular spontaneous nystagmus | 671 | ||
| Lesion location | 671 | ||
| Definitions and diagnostic criteria, bedside and laboratory diagnostic tests | 672 | ||
| Laboratory Diagnostic Tests | 675 | ||
| Caloric testing | 675 | ||
| Video head-impulse test | 675 | ||
| Cervical and ocular vestibular-evoked myogenic potentials | 675 | ||
| Differential Diagnosis and Other Clinical Problems | 675 | ||
| Central lesions mimicking acute unilateral vestibulopathy | 676 | ||
| Peripheral vestibular lesions | 677 | ||
| Short-term treatment options (including manipulative, pharmacologic, rehabilitative) | 678 | ||
| Symptomatic Treatment and Improvement of Central Compensation | 678 | ||
| Causative Treatment | 681 | ||
| Vestibular Physical Therapy | 682 | ||
| Supplementary data | 683 | ||
| References | 683 | ||
| Acute Diagnosis and Management of Stroke Presenting Dizziness or Vertigo | 687 | ||
| Key points | 687 | ||
| Case (Wallenberg syndrome) | 687 | ||
| Prevalence and pathomechanism | 688 | ||
| Stroke Presenting with Acute Vestibular Syndrome | 689 | ||
| Diagnosis and classification of strokes | 689 | ||
| Cerebellar Infarction | 689 | ||
| Posterior inferior cerebellar artery infarction | 689 | ||
| Anterior inferior cerebellar artery infarction | 692 | ||
| Superior cerebellar artery stroke | 692 | ||
| Medullary Infarction | 692 | ||
| Lateral medullary infarction (Wallenberg syndrome) | 692 | ||
| Medial medullary infarction | 693 | ||
| Vestibular nuclear infarct | 693 | ||
| Bedside and laboratory diagnostic tests | 693 | ||
| Bedside Evaluation | 693 | ||
| Laboratory Tests | 694 | ||
| Acute treatment options | 695 | ||
| General Principle | 695 | ||
| Medical Treatments | 695 | ||
| Surgical Treatments | 696 | ||
| Rehabilitation | 696 | ||
| Triage and disposition | 696 | ||
| Supplementary data | 696 | ||
| References | 697 | ||
| Medical and Nonstroke Neurologic Causes of Acute, Continuous Vestibular Symptoms | 699 | ||
| Key points | 699 | ||
| Introduction | 699 | ||
| General medical conditions without obvious structural neurologic disease | 700 | ||
| Pharmacologic Toxicity and Withdrawal | 702 | ||
| Environmental Toxins | 703 | ||
| Electrolyte, Endocrine, and Micronutrient Disturbances | 703 | ||
| Cardiovascular, Respiratory, Rheological, and Hematologic Disturbances | 705 | ||
| Nonstroke neurologic conditions | 706 | ||
| Demyelinating Disease, Especially Multiple Sclerosis | 706 | ||
| Posterior Fossa Neoplasms and Other Mass Lesions | 706 | ||
| Brainstem/Cerebellar Encephalitis (Infectious and Autoimmune Conditions) | 707 | ||
| Disorders of Intracranial Pressure and Brain Edema | 709 | ||
| Physiologic unmasking of occult or recovered neurologic disease | 710 | ||
| Summary | 710 | ||
| Acknowledgments | 711 | ||
| References | 711 | ||
| Index | 717 |