Podcasts about dix hallpike

En aquest episodi ens acompanya un convidat, el Dr José Luís Ballvé, metge de família del CAP la Florida de l'Hospitalet de Llobregat i investigador de l'IDIAP Jordi Gol Parlem amb ell del seu camp d'expertesa, el vertigen. Fem moltes referències a la maniobra de Dix-Hallpike per determinar si és un vertigen posicional paroxismal benigne … Continua llegint «Episodi 46: Vertigen»

Per aquest Menys és Més parlem d'una recomanació de l'Essencial La recomanació ens diu que no s'ha de prescriure medicació per al tractament del vertigen posicional paroxístic benigne, del tipus que sigui, neurolèptics, antihistamínics, benzodiazepines o la betahistina. Aquesta patologia s'ha de diagnosticar amb la maniobra de Dix-Hallpike i tractar primàriament amb la maniobra d'Epley. … Continua llegint «Sedants Vestibulars»

Story at-a-glance Vertigo causes a spinning sensation different from general dizziness and typically stems from inner ear issues, including displaced crystals (benign paroxysmal positional vertigo, or BPPV), infections or fluid buildup Diagnosis involves tests like the Dix-Hallpike maneuver to determine if ear crystals are out of place Physical therapy, particularly vestibular rehabilitation, helps retrain your brain to compensate for balance issues, while the Epley maneuver repositions displaced ear crystals Natural remedies include vitamin D, ginkgo biloba, avoiding caffeine and alcohol, staying hydrated, managing stress and getting adequate sleep While vertigo is usually not dangerous, seek immediate medical attention if it's accompanied by severe headache, slurred speech, weakness or vision changes

Jeff Walter, mastermind behind the loaded Dix-Hallpike, explains to J.J. Mowder-Tinney why we should be screening more older adults for BPPV but relying less on their symptom quality. Learning Objectives Interpret evidence-based clinical practice guidelines for benign paroxysmal positional vertigo (BPPV) Apply evidence-based, practical strategies to maximize identification of BPPV in older adults and their impact on participation in occupations such as sleeping or toileting Solve patient case scenarios involving vestibular agnosia Timestamps (00:00:00) Welcome (00:01:00) Introduction to guest (00:05:42) Why this clinical question? (00:22:46) Vestibular agnosia: lack of perception in BPPV (00:29:00) Advancements in testing for BPPV: the loaded Dix-Hallpike (00:43:05) Three main takeaways Resources Mentioned In Episode: Demonstration: Loaded Dix-Hallpike Testing - Jeff Walter | MedBridge Neuro Navigators is brought to you by MedBridge. If you'd like to earn continuing education credit for listening to this episode and access bonus takeaway handouts, log in to your MedBridge account and navigate to the course where you'll find accreditation details. If applicable, complete the post-course assessment and survey to be eligible for credit. The takeaway handout on MedBridge gives you the key points mentioned in this episode, along with additional resources you can implement into your practice right away. To hear more episodes of Neuro Navigators, visit https://www.medbridge.com/neuro-navigators. If you'd like to subscribe to MedBridge, visit https://www.medbridge.com/pricing/

Vestibular screening and treatment doesn't have to be only for vestibular specialists! On today's show we interviewed Dr. Christina Garrity, PT, DPT, NCS about the gaps that exist in vestibular care. All humans have vestibular systems and they can be negatively impacted by neurologic diagnoses, but how do you know if they aren't reporting dizziness? How do you build treatments into your plan of care when you have so many other things to focus on for “non-vestibular patients” or when you don't have goggles? We tackle these issues and more to help the neurologic therapist understand why and how to implement easy ways to reduce client falls.  The other issue in working with people with vestibular conditions is that they are all so different and after you take the course you may not know how to problem solve through the case. Where can you get mentorship and what could it look like? Christina believes therapists should integrate these pillars into any neuro client treatment plan of care: 1) Visual stabilization, 2) sensory integration, 3) habituation. Additionally, research shows that 25% of people could have BPPV even without the classic symptoms, so you should be screening for BPPV in anyone at a fall risk! Screening doesn't have to be complicated because you can do the modified side lying test vs the Dix-Hallpike. Her go to screening tests for all balance clients are: HIT, modified side lying test, dynamic visual acuity, modified CTSIB, FGA. Learn more about Christina: Labyrinth Physical Therapy & Wellness  www.LabyrinthPT.com Instagram: @vestibular_neuro_pt Website: www.LabyrinthPT.com and courses: https://labyrinthpt.com/courses

A simplified approach to dizziness/vertigo with tips from international expert, Dr. David Newman-Toker, Professor of Neurology, Ophthalmology, and Otolaryngology at Johns Hopkins University. 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. Original show notes here. Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | ask@gmail.com | Free CME! Show Segments Intro, Getting to know our guest Clinical Case Why can't patients describe their dizziness? Classifying dizziness The 3 vestibular syndrome buckets defined Episodic vestibular syndrome differential diagnosis Acute vestibular syndrome differential diagnosis Chronic vestibular syndrome differential diagnosis Challenges of medical history taking Approach to the acute vestibular syndrome/HINTS How to evaluate nystagmus How to perform the head impulse test (aka head thrust) How to perform “test of skew” (alternate cover testing) Recap of HINTS exam and discussion of MRI Signs and symptoms of cerebellar stroke Use of Dix-Hallpike for episodic vertigo What happens when you choose the wrong test Continuous versus triggered dizziness, or vertigo Meclizine use in BPPV How to cure horizontal canal BPPV Treatment for vestibular neuritis Treatment for Meniere's disease Who benefits from vestibular rehab/exercises Dizziness and giddiness Take home points Outro Credits Produced and Written by: Cyrus Askin MD Show Notes: Matthew Watto MD Hosts: Cyrus Askin MD, Stuart Brigham MD, Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD, FACP Guest: David Newman-Toker MD, PhD Sponsor: Better Help Visit BetterHelp.com/curb today to get 10% off your first month. Sponsor: Panacea Financial  Visit panaceafinancial.com today to learn how a bank for doctors, by doctors, can help you. Sponsor: Indeed  Visit Indeed.com/internalmedicine to start hiring now.

Every year approximately 2% of adults seek medical attention for moderate to severe dizziness. In this podcast, Dr Thomas Round, EKU Clinical Lead, talks to Dr Devina Maru, a GP Speciality Registrar in Greenwich with a special interest in ENT and audiology and RCGP National Clinical Champion for hearing loss, about sudden onset dizziness and vertigo. Their discussion includes the definition of dizziness and its associated symptoms, how common it is, causes of dizziness and vertigo, testing (such as the HINTs, Dix Hallpike, Romberg's, Weber's and Rinnes tests and the Epley manoeuvre) and management.

The Dix-Hallpike manoeuvre is performed for diagnosis and the Epley manoeuvre used for treatment of posterior canal benign paroxysmal positional vertigo (BPPV). However, musculoskeletal conditions may restrict utility of these manoeuvres. The Semont and liberatory manoeuvres are described in this article. These manoeuvres are simple and highly effective for the diagnosis and treatment of posterior canal BPPV.

We talk with Vestibular Therapist Matthew Johnston about the workup of dizziness and setting up patients for success with Vestibular Rehab. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/7Z6HZO --- SHOW NOTES In this episode, physical therapist Matthew Johnston joins Dr. Gopi Shah and Dr. Ashley Agan to discuss the process of vestibular evaluation, rehabilitation, and long-term care. First, Matthew speaks about the importance of obtaining a thorough past medical history to identify the patient's onset, duration, and aggravators/alleviators of dizziness. These responses help him set up a physical examination, which includes the Vestibulo-Ocular (VOR) Cancellation test, the Clinical Test of Sensory Interaction in Balance (CTSIB), and the Dix-Hallpike test. All of these diagnostic tools help him evaluate the patient's vestibulo-ocular reflex and check for nystagmus. Matthew distinguishes between Benign Paroxysmal Positional Vertigo (BPPV) and other conditions of vestibular hypofunction such as Meniere's Disease and vestibular neuronitis. While the former is curable, the latter conditions are more chronic and complex, so it is important to manage patient expectations and emphasize symptom alleviation. Overall, Matthew believes that identifying the affected ear canal and specifically matching the treatment to the canal is the most efficient way to treat patients. We close by talking about ways to improve the patient's physical therapy experience, through prescribed anti-nausea medications, maintenance exercises done in the home, and partnership between ENTs and physical therapists. --- RESOURCES Excel Physical Therapy: https://excelphysicaltherapy.com/

Dr. Peter Johns, MD and Jeff Walter, PT, DPT, NCS join Dani and Abbie to chat about vestibular dysfunction in the realm of Emergency Medicine. Dr. Johns, an emergency physician practicing in Ottawa Canada, also creates some amazingly informative YouTube videos that every vestibular clinician should watch! On this episode of Talk Dizzy To Me, the questions fly both ways between interviewers and guests to further discuss the roles of physicians and physical therapists in vestibular rehabilitation Here is a recent article Dr. Johns shared with us and co-authored: "The use and misuse of the Dix-Hallpike test in the emergency department" https://link.springer.com/article/10.1007/s43678-021-00110-1 Dr. Johns YouTube Channel: https://www.youtube.com/user/peterjohns84 Follow the link to submit topic or guest requests: https://forms.gle/81vh89WKCX2kx6zg7l Hosted by Dr. Abbie Ross, PT, NCS, and Dr. Danielle Tate, PT Where to find us: www.Vestibular.Today www.BalancingActRehab.com Facebook: @VestibularToday / @BalancingActRehab Instagram: @ Vestibular.Today / @BalancingActRehab Twitter: @VestibularToday / @BalActRehab

Episode 32: VertigoThe sun rises over the San Joaquin Valley, California, today is October 20, 2020.It’s time to talk about vaccines again. The ACIP (Advisory Committee on Immunization Practices) posted new recommendations for meningococcal vaccinations on September 25, 2020. There are two kinds of meningococcal vaccines in the US: 1. Meningococcal conjugate or MenACWY vaccines (Menactra®, Menveo®, and MenQuadfi®)2. Serogroup B meningococcal or MenB vaccines (Bexsero® and Trumenba®). Let’s discuss how they are given.MenACWY: Menactra (MenACWY-D), Menveo (MenACWY-CRW), and MenQuadfi (MenACWY-TT) MenACWY routine: The meningococcal conjugate vaccine should be given to ALL PATIENTS at 11 to 12 years old, with a booster dose at age 16. Remember, it’s a two-dose series, the booster dose at age 16 is important to provide protection during the ages of highest risk of infection. So, that was easy. The hardest part is for patients younger than 10 years old because only patients who are at risk receive routine meningococcal conjugate vaccines before age 11. MenACWY in special groups: This vaccine is given to patients older than 2 months old only if they are at increased risk for meningitis (i.e., persistent complement component deficiencies; persons receiving a complement inhibitor such as eculizumab [Soliris] or ravulizumab [Ultomiris]); persons who have anatomic or functional asplenia; persons with HIV infection; microbiologists routinely exposed to Neisseria meningitidis; persons at increased risk in an outbreak; persons who travel to or live in hyperendemic or epidemic areas; unvaccinated or incompletely vaccinated first-year college students living in residence halls; and military recruits.) I invite you to consult ACIP recommendations regarding vaccination in special groups. MenB: Trumenba (MenB-FHbp), Bexsero (MenB-4C)  MenB shared decision: MenB vaccination is not routinely recommended for all adolescents. It may be given to adolescents and young adults (16 through 23 years old, preferred age is 16-18 years old) on the basis of shared clinical decision. Those who decide to receive MenB vaccine, receive two doses 1-6 months apart depending on the brand name you use. MenB vaccines are not recommended before age 10 in any case. Adults older than 24 and older don’t need MenB unless they are at increased risk.MenB in special groups:Patients with certain medical conditions (persons with persistent complement component deficiencies; receiving a complement inhibitor; with anatomic or functional asplenia; microbiologists exposed to isolates of N. meningitidis; and persons at risk in outbreaks) should receive MenB vaccine. These recommendations will be included in the updated 2021 immunization schedules, and the AAFP will review changes to the schedules once they are available (1).This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program, from Bakersfield, California. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care since 1971.____________________________“A man is who he thinks about all day long” –Waldo Emerson.If you think you are not good enough, you may not reach your goals. So, think positive about yourself all day long, and you will become that person you think you are and will reach your goals.Hi, this is Dr Carranza, I’m a PGY3, and today I will interview a special guest.Question Number 1: Who are you? Hello, I’m Jagdeep Sandhu. I’m a 4th year medical student from Ross University, currently doing a sub-internship in family medicine. I’m originally from Seattle, Washington. I have an Indian ancestry, so I enjoy meditating and cooking Indian dishes.Question number 2: What did you learn this week? Lightheadedness vs VertigoThis week we learned about dizziness and its differentials. It is important to differentiate dizziness vs lightheaded because a lot of patients will say they are dizzy when they are truly lightheaded. To be honest dizziness (at least for me) is one of the toughest complaints to get from a patient as it is hard to pinpoint its etiology.Important questions to ask the patient are:Do you feel like you’re going to pass out? Do you experience a sense of darkness in front of your eyes? (points to syncope)Is the room spinning? Are you having nausea or vomiting? Ringing in your ears? (points to vertigo)  Peripheral VertigoPeripheral refers to vertigo originated from the ear structures, whereas central from the brainstem. Differentials of peripheral vertigo include:Benign paroxysmal positional vertigo: Transient episodes of vertigo caused by stimulation of vestibular sense organs, this is most commonly due to calcium debris within the posterior semicircular canal, known as canalithiasis. It affects middle-age and older patients; and twice as many women than men. Classically, patients describe a brief spinning sensation brought on when turning in bed or tilting the head backward to look up. The dizziness is quite brief, usually seconds, rarely minutes.The way to Evaluate/diagnose BPPV is with Dix-Hallpike maneuver (turn the patient’s head 45 degrees to one side, then you help you lie back quickly so their head hangs slightly over the edge of the table. If horizontal or rotation nystagmus is noted, the patient has BPPV) and can be cured with Epley’s maneuver.Vestibular neuritis: This is inflammation of the vestibular nerve, which is usually caused by a viral infection. It’s characterized by rapid onset of severe, persistent vertigo, nausea, vomiting, and gait instability. Hearing is preserved but if there is hearing loss(unilateral), then it is diagnosed as labrynthitis.  You can Evaluate/diagnose with a positive head impulse (or head thrust) test and gait instability but know that the patient is still able to ambulate. (lasts a few days and resolves spontaneously) Herpes zoster oticus: It is also known as Ramsay Hunt syndrome when it causes facial paralysis; it occurs due to latent VZV virus in the geniculate ganglion.  The patient will complain of ear pain and vertigo. On exam, you will find vesicles in the auditory canal and auricle along with ipsilateral facial palsy. You can treat with Acyclovir or Corticosteroids. Meniere disease: Itoccursdue to excess endolymphatic fluid pressure, which causes episodic inner ear dysfunctionresulting in the classic triad of vertigo lasting for minutes to hours, usually associated with unilateral tinnitus and hearing loss. Unfortunately, the hearing loss can sometimes be permanent. It usually affects one ear and although it can occur at any age, most cases start between young adults and middle age adults. Evaluate and diagnose clinical features, get an audiogram for hearing loss. Patients go into remission spontaneously but it can reoccur. Other causes of peripheral vertigo: Labyrinthine concussion (traumatic peripheral vestibular injury)Perilymphatic fistula (complication of head injury, barotrauma, or heavy lifting in which a fistula develops at the otic capsule)Aminoglycoside toxicityVestibular schwannoma (unilateral hearing loss associated with neurofibromatosis type 2) Central VertigoVestibular migraine: The mechanism is unknown, so you have to rely on the patient's history of vertigo associated with migraine headache and classic migraine symptoms such as visual aura, photophobia, or phonophobia.Brainstem ischemia: which is due to embolic, atherosclerotic occlusions of the vertebra-basilar arterial system. A few things fall under this category such as TIA, Wallenberg syndrome (lateral medullary infarction), Labyrinthine infarction (Anterior Inferior cerebellar artery) etc. Evaluate and diagnose with Imaging of the head and treat according to diagnosis.  Question number 3: Why is that knowledge important for you and your patients? It is important for when we are working at both the clinic and at the hospital as recognizing serious vertigo can help us plan for intervention. For example, if a patient presents with vertigo and on exam you find vesicles on their ear and facial paralysis then you can immediately begin therapy with a combination of Valacyclovir and Prednisone but if it is a severe case then the patient might need IV treatment.Also, if the patient has vascular risk factors then it is important to keep ischemia as part of your differential when your patient presents with acute sustained vertigo. Remember that for any stroke time of onset is KEY! CT should be done if MRI is not available but MRI is more sensitive for cerebellar infarctions.Question number 4: How did you get that knowledge? (learning habits)I did an ENT rotation in my 3rd yeard of medical school and learned from Dr Trang. I recommend that rotation to all medical students. I also searched in UpToDate, FP notebook app, AAFP and my attendings. See details below.____________________________Speaking Medical: Otolith by Gina Cha, MDStones are located in many unsuspected places in the body. Such is the case of otoliths. An otolith is a calcium carbonate structure in the saccule or utricle of the inner ear, specifically in the vestibular system of vertebrates. The saccule and utricle, in turn, together make the otolith organs. An otolith can cause great trouble if it’s out of its regular place. When otoliths are dislodged from their usual position within the utricle, and migrate into one of the semicircular canals (most commonly the posterior canal), moving the head causes movement of the heavier otolith debris in the affected canal causing abnormal endolymph fluid displacement and a resultant sensation of vertigo.____________________________Espanish Por Favor: Serenoby Claudia Carranza, MD, and Hector Arreaza, MDHi! This is Dr Carranza with our section “Espanish Por Favor”. The word of the week is SERENO (maybe we can have beach waves crushing in the background). SERENO is a state of mind, a peaceful feeling. To be SERENO means to be calm, peaceful, untroubled, tranquil. Sometimes when people are frustrated or too excited you can say: “Sereno, no te preocupes,” which you can loosely translate as “chill, don’t worry.”Sometimes you might ask someone how they are doing and they can say: “Sereno, sin preocupaciones,” which means “calm, without worries.” Nowadays not many people might actually feel that way but you can always remind them to lay back, relax, and take a deep breath “SERENO!”Another meanings of the word sereno includes “humidity on the atmosphere at night.” In some Latin American countries, sereno can make you sick if you, for example, shower and go outside at night, or you can get worse if you are sick and go outside. The sereno can also be used in folk medicine to “macerate” some herbal teas or remedies giving it a special property to cure illnesses. This may not be used in all countries but at least I know it’s true in Mexico and Venezuela.____________________________For your Sanity: Supermanby Tana Parker, MD Friend 1: Do you want to hear a really good Batman impression?Friend 2: Sure, go on. Friend 1: NOT THE KRYPTONITE!Friend 2: That’s Superman.Friend 1: Thanks, man, I've been practicing. “eBay is so useless. I tried to look up lighters and all they had was 13,749 matches.”“I just saw my wife trip and fall while carrying a laundry basket full of ironed clothes. I watched it all unfold.”I made a playlist for hiking. It has music from Peanuts , the Cranberries, and Eminem. I call it my trail mix._________________________Conclusion: Now we conclude our episode number 32 “Vertigo.” Dr Carranza and Jagdeep had an entertaining conversation about the differential diagnosis of peripheral and central vertigo. Don’t forget to practice the Dix-Hallpike and Epley’s maneuvers for BPPV. Otolith is a tiny stone located in the inner ear that can cause vertigo when it gets stuck in the semicircular canals. The word sereno (pronounced (say-RAY-noe) as an adjective is pretty much the same as the English serene, however, Dr Arreaza explained that sereno as a noun refers to the humidity on the air thought to be the “cause” of many ailments in some Latin cultures. Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Arianna Lundquist, Claudia Carranza, Jagdeep Sandhu, Gina Cha, and Tana Parker. Audio edition: Suraj Amrutia. See you next week!     _____________________References:Meningococcal vaccine updates: https://www.aafp.org/news/health-of-the-public/20201007meningococcalvacc.html. Review full article at: https://www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm?s_cid=rr6909a1_w Labuguen, Ronald H., M.D., University of Southern California, Los Angeles, California, Initial Evaluation of Vertigo, Am Fam Physician. 2006 Jan 15;73(2):244-251. https://www.aafp.org/afp/2006/0115/p244.html Furman, Joseph M, MD, PhD, and Jason JS Barton, MD, PhD, FRCPC, Evaluation of the patient with vertigo, UptoDate, last updated: Feb 11, 2020. https://www.uptodate.com/contents/causes-of-vertigo?search=vertigo§ionRank=1&usage_type=default&anchor=H5&source=machineLearning&selectedTitle=3~150&display_rank=3#H20 

This week Dr. Jeff Walter, PT, NCS is back! He joins Dr. Abbie Ross, PT, NCS, Dr. Danielle Tate, PT, and special guest host Dr. Kelly Keener, PT to discuss the findings of his newly published article “Optimizing Testing for BPPV – The Loaded Dix-Hallpike”. Episode Resources: Jeff Walter's Loaded Dix-Hallpike Test/Paper: https://documentcloud.adobe.com/link/review?uri=urn%3Aaaid%3Ascds%3AUS%3A2249cb21-bd33-4842-8ef1-0e4966972898&fbclid=IwAR2gR-TN7khlY9ok-YIqeCpK6i5DAovrYb_U1safwEounG_LcN-HQzNanVQ#pageNum=1 Boselli Paper: Quantitative analysis of benign paroxysmal positional vertigo fatigue under canalithiasis conditions https://www.sciencedirect.com/science/article/abs/pii/S0021929014001894 All of Jeff Walter's Courses on MedBridge: https://www.medbridgeeducation.com/about/instructor/jeff-walter-dpt-ncs Follow the link to submit topic or guest requests: https://forms.gle/81vh89WKCX2kx6zg7l Hosted by Dr. Abbie Ross, PT, NCS and Dr. Danielle Tate, PT Where to find us: www.Vestibular.Today www.BalancingActRehab.com Facebook: @VestibularToday / @BalancingActRehab Instagram: @ Vestibular.Today / @BalancingActRehab Twitter: @VestibularToday / @BalActRehab Video Link: https://youtu.be/XY6cC_LMvMA

Avsnitt 34 - Fredde pratar om en klassisk yrselundersökning, Joe om nya öronappar och Miriam om avföringsfrekvens.

I hope you enjoy these bits of the show that don't really fit in. After we were done I just kept recording. He was a good sport and let me geek out. I have always been, and will always continue to be, excited to learn more about our bodies; My curious mind will never quiet. I gained more then a few wisdom nuggets in this quick 20 mins. What a blast to talk shop with Brian!   BONUS TIDBITS!!!! Pirformis - Small muscle located deep in the buttock, behind the gluteus maximus.   Sciatica - Pain that radiates down the sciatic nerve.   Sciatic Nerve - Largest single nerve in the human body from each side of the lower spine and going distal.   Straight Leg Raise - Test done during physical exam of a patient with low back pain to assess for underlying herniated disc.   Herniation (Herniated Disk) - AKA “Slipped” or “Ruptured” disk/disc, a crack of the outer layer of cartilage allowing some of the inner cartilage to protrude out of the disk.   Dix-Hallpike - Diagnostic test used to identify Benign Paroxysmal Positional Vertigo (BPPV)   BPPV - Spinning sensation (Vertigo), often with nausea, resulting from disorder affecting the inner ear.   Epley Maneuver - Used to treat BPPV with attempts to relocate anatomy of the semicircular canal of the inner ear.   Lateral Epicondylitis (Tennis Elbow) - Irritation of the tissue connecting the forearm muscle to the elbow.   Achilles Tendinitis - An injury of the Achilles tendon, which connects the calf muscle to the heel bone.   Peroneal Tendonitis - Inflammation of the tendon running behind the outter ankle (lateral malleolus).   Collapsed Arch (Fallen Arch) - AKA ‘Pes Planus,” loss of arch in which the entire sole of the foot is either partially or completely in contact with the ground.   Rooke Boot -  Dressing/orthosis designed to completely surround the lower leg to prevent ulcers or treat a variety of conditions such as ischemia, neuropathy, and more.   Plantar-Flex - Movement of the foot, or toes, in the direction of the sole   AFO (Ankle-Foot Orthosis) - Support to help the position and motion of the ankle.  Often associated with Foot-Drop.   Foot Drop (Drop Foot) - Difficulty lifting the front of the foot up when walking.  Due to neurological, muscular, or anatomical reason.  Most common cause from sciatic/peroneal nerve injury.   Snuffbox Injury/tenderness - Pain over the anatomical snuffbox of the hand.  Made of by the extensor pollicis longus,, extensor pollicis brevis, and the abductor pollicis longus.   Avascular Necrosis (AVN) - Death of bone due to lack of blood supply.   FOOSH Injury - Fall on out stretched hand (fall when trying to catch one self, not uncommon to result in fractures)   Dupuytren’s Contracture - A gradual thickening and tightening of tissue under the skin in the hand.   De Quervain’s Tenosynovitis - Pain to the thumb side of the wrist.   Finkelstien Test - Used in the diagnosis of De Quervian’s.   Thumb Spica - Splint used to isolate and immobilize the thumb and usually the wrist.   NSAIDs - Non-steroidal antiinflammatories, Ibuprofen (Motrin/Advil), Aleve (Naproxen), Aspirin, Celebrex, Etc.   Baker’s cyst - Fluid-filled cyst (sack) that causes a bulge and feeling of tightness behind the knee.  A sign of acute (torn cartilage) or chronic (arthritis) inflammation.   Wrist Cock-Up Brace   For educations purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.

Dizzy! My head is spinning; Like a whirlpool it never ends; And it's you girl making it spin...or is it Benign Paroxysmal Positional Vertigo?  Or Labyrinthitis?  Or a posterior stroke?  Luckily this podcast from NUH DREEAM with Emergency Medicine consultant and PHEM enthusiast Dr Chris Gough will help us through the dizzying world of vertigo. For more information including videos going through the HINTs exam, Dix-Hallpike and Epley manoeuvres go to www.takeaurally.com. You can find Take Aurally on both Facebook and Twitter.

A simplified approach to dizziness/vertigo with tips from international expert, Dr. David Newman-Toker, Professor of Neurology, Ophthalmology and Otolaryngology at Johns Hopkins University. 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. Special thanks to Dr. Cyrus Askin who found our expert, wrote the questions for this episode, and acted as our cohost. Full show notes available at http://thecurbsiders.com/podcast Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Case: A 45-year-old man presents to the emergency department because of continuous dizziness, nausea, vomiting and unsteady gait that began 18 hours earlier. Time Stamps 00:00 Intro 04:16 Getting to know our guest 11:56 Clinical Case 13:13 Why can’t patients describe their dizziness? 15:20 Classifying dizziness 18:35 The 3 vestibular syndrome buckets defined 22:14 Episodic vestibular syndrome differential diagnosis 26:49 Acute vestibular syndrome differential diagnosis 28:08 Chronic vestibular syndrome differential diagnosis 30:15 Challenges of medical history taking 32:10 Approach to the acute vestibular syndrome/HINTS 33:38 How to evaluate nystagmus 38:00 How to perform the head impulse test (aka head thrust) 45:56 How to perform “test of skew” (alternate cover testing) 47:45 Recap of HINTS exam and discussion of MRI 50:50 Signs and symptoms of cerebellar stroke 55:17 Use of Dix-Hallpike for episodic vertigo 57:00 How to perform Dix-Hallpike 59:50 How to perform the Epley maneuver 64:17 What happens when you choose the wrong test 66:10 Continuous versus triggered dizziness, or vertigo 67:40 Meclizine use in BPPV 69:25 How to cure horizontal canal BPPV 71:00 Treatment for vestibular neuritis 72:56 Treatment for Meniere’s disease 74:32 Who benefits from vestibular rehab/exercises 77:23 Dizziness and giddiness 78:15 Take home points 81:06 Outro Tags: vertigo, dizziness, presyncope, ataxia, stroke, BPPV, Meniere’s, disease, neuritis, vestibular, syndrome, episodic, meclizine, migraine, gait, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

1) Transverse myelitis and 2) Topic of the month: Dizziness. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Alex Bragg interviews Dr. Thomas Scott about the evidence-based guideline on transverse myelitis. In the next segment, Dr. Stacey Clardy is reading our e-Pearl of the week about Gates' rule of 4 of the brainstem. In the next part of the podcast Dr. Ted Burns interviews Drs. Kevin Kerber and Robert W. Baloh about Dix-Hallpike maneuver. The participants had nothing to disclose except Drs. Scott, Clardy, Burns, Kerber and Baloh.Dr. Scott has received funding for travel or speaker honoraria from, served on the speakers' bureaus and scientific advisory boards of, and performed consultation work for Acorda Therapeutics Inc., Avanir Pharmaceuticals, Biogen Idec, Novartis, and Teva Pharmaceutical Industries Ltd.; served as an associate editor for BMC Neurology; and has received research support from Biogen Idec, National Multiple Sclerosis Society, Novartis, Pittsburgh Foundation, and Teva Pharmaceutical Industries Ltd.Dr. Clardy serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Burns serves as Podcast Editor for Neurology®; performs EMG studies in his neuromuscular practice (30% effort); and has received research support from the Myasthenia Gravis Foundation of America and Knopp Neurosciences Inc..Dr. Kerber has served as a consultant for and received speaker honoraria from the American Academy of Neurology; receives publishing royalties for Clinical Neurophysiology of the Vestibular System, 4th edition (Oxford University Press, 2010); and receives research support from the NIH/NCRR and the Agency for Healthcare Research and Quality.Dr. Baloh has received speaker honoraria from the American Academy of Neurology; serves on the editorial board of Neurology; receives publishing royalties for Clinical Neurophysiology of the Vestibular System, 4th edition (Oxford University Press, 2010); and receives research support from the NIH.