The bedside assessment of vertigo

Kaski, Diego; Seemungal, Barry M.

doi:10.7861/clinmedicine.10-4-402

Cited by 9 publications

(6 citation statements)

References 13 publications

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“…When horizontal or torsional nystagmus is present, these may reflect either a peripheral vestibulopathy or a lesion to central vestibular connections. 8 A simple bedside test to distinguish these is the ‘head impulse test’ that tests the vestibulo-ocular reflex, and whose impairment strongly suggests dysfunction of peripheral pathways. The test is performed by the examiner rapidly rotating the head to either side while asking the patient to fixate straight ahead at a set point (e.g.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic confusion resolved by being upbeat

Kakar

Kamdar

Prabhudev

et al. 2012

JRSM Cardiovascular Disease

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The classical stroke presentation – captured by the public health campaign mnemonic FAST (face, arm, speech, time) – does not apply in a large number of stroke cases; yet establishing a prompt diagnosis is imperative for optimal management. Here, we describe a patient with acute bulbar weakness, numbness in all extremities and an apparently normal magnetic resonance imaging (MRI) of the brain upon admission for whom even the fundamental question of whether this reflected a central or peripheral nervous system process was unclear. The critical localizing sign was upbeat nystagmus that denotes a brainstem cause. MRI of the brain in the second week confirmed a diagnosis of medial medullary infarction.

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Section: Discussionmentioning

confidence: 99%

Diagnostic confusion resolved by being upbeat

Kakar

Kamdar

Prabhudev

et al. 2012

JRSM Cardiovascular Disease

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“…In addition, EEG and evoked Reaction Potentials (ERPs) have been shown to distinguish children with sensory processing disorders from typically developing children with 86% accuracy in a small study ( Davies & Gavin, 2007 ). Wearable devices such as smartwatches and activity trackers can measure markers such as heart rate and skin conductance in response to daily sensory experiences ( Black et al, 2020 ; Kaski & Seemungal, 2010 ; Roos & Slavich, 2023 ). There are also several health technologies such as diary apps that can help individuals monitor pain and vestibular symptoms ( Martin et al, 2020 ), as well as emerging software to access smartphone accelerometers to assess balance ( Patterson, 2014 ).…”

Section: Sensorimotor: Somatosensory and Pain Processing Vestibular B...mentioning

confidence: 99%

The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology

Gilgoff,

Mengelkoch,

Elbers

et al. 2024

Stress

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Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.

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“…Peripheral patterns of nystagmus include a spontaneous horizontal/torsional nystagmus enhanced by removal of fixation (https://www.youtube. com/watch?v=eGcUTfeHvZg) and following Alexanders' Law (Kaski and Seemungal, 2010). Central patterns of nystagmus include vertical spontaneous nystagmus and direction-changing ("gaze-evoked") nystagmus (Kaski and Seemungal, 2010).…”

Section: Diagnostic Eye Movement Examination For Dizziness Patients I...mentioning

confidence: 99%

“…com/watch?v=eGcUTfeHvZg) and following Alexanders' Law (Kaski and Seemungal, 2010). Central patterns of nystagmus include vertical spontaneous nystagmus and direction-changing ("gaze-evoked") nystagmus (Kaski and Seemungal, 2010). Eye movement examination requires experience to observe the small intricate eye movements that can result from the pathologies causing nystagmus.…”

Section: Diagnostic Eye Movement Examination For Dizziness Patients I...mentioning

confidence: 99%

Hyperacute assessment of vertigo in suspected stroke

Morrow,

Koohi,

Kaski

2023

Front. Stroke

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The management of patients with acute vertigo is most challenging in the hyperacute phase, both due to the complexity of vertigo as a symptom, the range of possible causes, and the lack of training in neuro-otology for non-specialists. Perhaps of greatest relevance is differentiating between peripheral (usually benign, e.g., inner ear) causes and central (potentially more sinister, e.g., stroke) causes. Several diagnostic algorithms have been introduced to help detect stroke in patients with acute vertigo. However, these algorithms have been largely validated in patients with an acute vestibular syndrome (with nystagmus) for whom symptoms have been present for a minimum of 24 h. The most challenging period within the diagnostic process is the hyperacute phase that determines triage and treatment, but where none of the established algorithms have been validated. In this review, we specifically describe practical implementation considerations for evaluating patients with hyperacute vertigo, including the timing of diagnostic testing within the emergency department pathway, resource availability, and pitfalls associated with current practices.

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The bedside assessment of vertigo

Cited by 9 publications

References 13 publications

Diagnostic confusion resolved by being upbeat

Diagnostic confusion resolved by being upbeat

The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology

Hyperacute assessment of vertigo in suspected stroke

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