Dizziness Depot

In my last blog post, I reviewed the new GRACE 3 guideline for acute dizziness and vertigo in the emergency department. The first recommendation from that guideline was that Emergency Department (ED) physicians need training in bedside tests such as the HINTS protocol, the Dix-Hallpike test, and performing the Epley maneuver when applicable. I also suggested that those of us

There have been symptom reports consistent with Meniere’s disease for many years yet it still remains poorly understood. There is some suspicion that historical figures such as Julius Caesar, Martin Luther, and even Vincent Van Gogh may have had the condition.4 The condition was first theorized to be an inner ear condition by French physician Dr. Prosper Meniere in 1861.3

The Society for Academic Emergency Medicine, in May of 2023, published GRACE-3. Grace is an acronym for Guideline for Reasonable and Appropriate Care in the Emergency Department. GRACE 1 and 2 offer guidelines for chest pain and abdominal pain. GRACE-3 addresses “acute vertigo and dizziness in the emergency department”. This is a welcome, much needed, and frankly overdue development as

A vestibular evoked myogenic potential, or VEMP, is a measure of vestibular function that only recently is seeing widespread clinical use. A VEMP is a measurement of a change in muscle activity in response to stimulating the vestibular system. These measures allows us to intuit the function of specific end organs of the inner ear, predominantly reflecting the function of

Diagnosing episodic dizziness can be challenging as most patients are asymptomatic when they arrive for examination. Episodes of dizziness can be broken down into two broad categories based on two variables: Triggered vs. Spontaneous episodes Episodes of less than five minutes duration or more than five minutes duration. Fortunately, these categories align in that most short duration dizziness is triggered,

Vitamin D is an essential nutrient, necessary for building and maintaining healthy bone structure by promoting calcium absorption in the body. Despite its importance, vitamin D is not found naturally in many foods. Also, with populations spending less time outdoors, vitamin D obtained naturally from sunlight is likely declining. As such, vitamin D deficiency is widespread with an estimated 1

Vestibular disorders are the most common reason for symptoms of dizziness regardless of the clinical setting. A five study average reveals that vestibular disorders account for around 45% of all dizziness and are much more common than cardiovascular or potentially life threatening neurologic causes for dizziness. Despite the magnitude of individuals suffering from vestibular type dizziness, these disorders are historically

The most common vestibular disorder is the condition of Benign Paroxysmal Positional Vertigo (BPPV), which accounts for up to 40% of all patients experiencing vertigo. This condition is the result of otoconia (inner ear crystals) migrating into one of the semicircular canals (head turn sensors) of the inner ear. The majority of cases can be readily treated with canalith repositioning

Just imagine, you wake up one morning and the entire room is spinning around you. You have no idea why this is happening or how to make it stop. You notice that if you remain still the spinning will stop, but whenever you move again, the spinning sensation starts again. Because the world appears to be spinning around, you become

Multiple sources agree that the most common causes of the complaints of dizziness and vertigo include benign paroxysmal positional vertigo, vestibular migraine, orthostatic hypotension, vestibular neuritis, and Ménière’s disease.  There are subtle differences in the symptom presentation, duration, provoking or exacerbating factors that guide the examiner to the diagnosis. Vestibular neuritis almost always presents as an isolated episode of vertigo