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Just the Facts: How to assess a patient with constant significant vertigo and nystagmus in the emergency department

  • Peter Johns (a1) and Hans Rosenberg (a1)

Extract

A 43-year-old female presents to the emergency department (ED) after she woke up with the sensation that the room was spinning and vomited three times at home. She continues to have significant vertigo when she presents to the ED 4 hours later. Her symptoms are worsened by head movement. She has noticed some unsteadiness but is able to walk unaided. When you examine her, she has left-beating horizontal nystagmus with a slight rotatory component to the left.

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Corresponding author

Correspondence to: Dr. Peter Johns, 1053 Carling Ave., Ottawa, ONK1Y 4E9; Email: pjohns@toh.ca

References

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1.Tarnutzer, AA, Berkowitz, AL, Robinson, KA, Hsieh, YH, Newman-Toker, DE. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 2011;183(9):E571–92.
2.Goldman, B, Johns, P. Tintinalli emergency medicine. 9th ed. New York: McGraw-Hill Education; 2019.
3.Newman-Toker, DE, Kerber, KA, Hsieh, Y, et al. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med 2013;20(10):987–96.
4.Fishman, JM, Burgess, C, Waddell, A. Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Datab Syst Rev 2011(5):CD008607.
5.Saber-Tehrani, AS, Kattah, JC, Mantokoudis, G, et al. Small strokes causing severe vertigo: frequency of false-negative MRIs and nonlacunar mechanisms. Neurology 2014;83:169–73.

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Just the Facts: How to assess a patient with constant significant vertigo and nystagmus in the emergency department

  • Peter Johns (a1) and Hans Rosenberg (a1)

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