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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, March 31, 2016

Approach to Dizziness

emDocs - March 31, 2016 - Author: Lotstein J. - Edited by: Koyfman A. and Long B.
The dizzy patient can be a difficult patient encounter with multiple dangerous diagnoses to consider. While many patients are unable to reliably describe whether they are suffering from presyncope or vertigo (and thus may require an evaluation for both entities), some will provide historical clues or descriptors that will allow a narrowing of the differential at this initial step. As always, immediate life-threatening conditions must be considered such as arrhythmias, hemorrhage, or sepsis. Many of these conditions will be readily apparent on either the initial vital signs (including blood glucose and telemetry/EKG) or with basic labs (such as a CBC and a BMP). If the patient describes true vertigo, a thorough neurologic exam is key and the HiNTS exam (best in the patient with acute vestibular syndrome), while difficult for the inexperienced practitioner, has been shown to have excellent sensitivity and specificity for acute stroke. With practice, one should find him/herself comfortably able to navigate the treacherous waters of the “weak and dizzy” and be able to safely decide on the appropriate disposition of these patients."

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TOKC Blog / Morning report 6/18/2013 - by jkhadpe
"What is the HiNTS exam?
A set of 3 tests used to specifically differentiate central from peripheral etiology in setting of acute vestibular syndrome/ AVS (rapid onset (seconds to hours) of vertigo, nausea/vomiting and gait unsteadiness with head-motion intolerance and nystagmus lasting days to weeks. BPPV is not in the differential of AVS, because, according to the authors, BPPV should last less than 24hrs).
  • Hi = Head impulse testing
  • N = Nystagmus
  • TS = Test of skew
"Check out the links below for videos of the exam, and a great PV card from Dr. Lin at ALIEM."