Thanks to Dr Kavita Patel for her presentation. Also see below for examples of the dix-hallpike, nystagmus, skew and the head impulse test.
Vertigo kavita patel Dec 17
Head impulse test:
Review this presentation by Dr Martin Bicket with Dr Shona McIntyre for HMO teaching.
Apologies for the scratchy lofi audio quality – subtitles have been transcribed for clarity and it is recommended that you use this feature.
- Classic history for subarachnoid haemorrhage (SAH) is sudden onset, ‘thunderclap’, worst onset headache and clinicians should be sensitive to not lead the patient to include nor exclude these features
- Lumbar puncture cannot yet be completely excluded from the workup of (SAH) after negative CT brain, despite the Perry study; consult with senior staff
- Presence of risk factors like increasing age, immunosuppresion, malignancy, autoimmune or connective tissue disorders should lower the threshold for investigation in general
- Consider lumbar puncture in cases of suspected viral meningitis, particularly for those patients who are not progressing
- CT brain still has utility in general, even in the younger patient – consult with seniors as practice variation exists
- Do not forget extracranial causes of headache like giant cell arteritis / temporal arteritis and glaucoma
Thanks Dr Jess Roberts for her presentation on interpretation of the brain CT.ct-brain-dr-j-roberts