1. The first key in assessing a patients with dizziness is to define the problem: dizziness is not a medical term, and vertigo is not a diagnosis.
2. If a patient has nystagmus, it is important to interpret and document the nystagmus in a clinically meaningful way which will support your diagnostic decision making.
3. To adequately test the cerebellum, all three of the following must be assessed: limb ataxia, truncal ataxia, and oculomotor control.
4. Correct patient selection is essential when performing the Dix-Hallpike maneuver or the Head Thrust Test. The only patients who are appropriate candidates for the Dix-Hallpike test are those with a history consistent with BPPV. Similarly, the only patients who are appropriate candidates for the head thrust test (and the HINTS exam) are those with acute vestibular syndrome.
5. If the patient has the constellation of signs and symptoms that comprise acute vestibular syndrome, perform the HINTS exam to attempt to distinguish central from peripheral causes
6. Recognize that brain CT rarely identifies early-stage cerebellar infarction. DWMRI is reasonably sensitive for detecting cerebellar infarction early, but it is less sensitive than appropriately performed oculomotor assessment.
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