April 2015: Central vs Peripheral Vertigo and the HINTS exam
This month JC is looking at the patients who present to the ED with a complaint of ‘dizziness’. There are a host of challenges in assessing these patients. Discerning patient’s reports of dizziness, vertigo, giddiness, unsteadiness, wooziness, shakiness or lightheadedness can be daunting. Avoiding clinical missteps and recognizing those at highest risk for potentially life-threatening central causes can be a cause of significant anxiety for clinicians assessing these patients. CT is often unhelpful and MRI particularly in the acute setting may have false negative findings. The HINTS exam is a 3-component clinical assessment tool that may help distinguish central from peripheral vertigo. We will review three articles regarding the tests utility and I would encourage you to check out the instructional video by Dr. Newman-Toker. (here). I have also included an interesting piece by one of my favorite authors Atul Gawandi regarding quality of life issues in nursing home patients and how one physician was able to affect change.