emDocs - June 15, 2020 - By Pierce A - Edited by: Koyfman, A and Long B
"Take Home Points
- Consider stroke at the most likely diagnosis for abrupt onset of neurologic symptoms
- The timing and triggers diagnostic approach for patients with dizziness is helpful in reducing misdiagnosis and decreasing diagnostic test overuse.
- Fewer than 20% of stroke patients that present with AVS have focal neurological signs
- NIH stroke scales of 0 occur with posterior circulation strokes. Performing the HINTS exam and targeted neurologic exam of the visual fields, cranial nerves, and cerebellar function including and evaluation of gait and truncal ataxia can help reduce misdiagnosis.
- Early brain imaging is frequently non-diagnostic
- Findings that suggest Central Causes of Dizziness:
- Nystagmus that is dominantly vertical or torsional or dominantly horizontal, direction changing on left/right gaze
- Test of Skew with skew deviation
- Head Impulse Test – bilaterally normal (no corrective saccade)
- Limb ataxia, dysarthria, diplopia, ptosis, anisocoria, facial sensory loss (pain/temperature), unilateral decreased hearing
- Ataxia
- Dix-Hallpike test findings that suggest a central cause
- Variable direction
- Variable duration
- Supine roll test findings that suggest a central cause
- Variable direction
- Variable duration
- Abnormal cranial nerve or cerebellar function
- Diplopia
- Headache"