A patient's perspective on what it feels like to have vestibular neuritis. Also how to diagnose it with the HINTS plus exam.

@neuralconsult Finkelstein's sign

@HyeRealityL Neck cracking can lead to strokes, as well as BPPV.

@HyeRealityL I'm sure you're fine, as most causes of vertigo are not caused by a dangerous disease, But just so you know, the most common dangerous cause of dizziness is a stroke, and they don't show up on CT scans.

@drcolindunkley I've had patients with BPPV say they are lightheaded and had a man with sepsis say he was spinning, complete with the finger spinning gesture. So you can ask the question, but how long, how many episodes, what brings it on are much better questions.

@drcolindunkley The way the patient describes their dizziness (lightheaded or spinny) is not reliable and cannot be used to rule in or out any cause of dizziness. I would think this is especially true in children.

@GhazwanFahmi I think if you can cure him with an Epley, no need. If you can't cure him, or you can't clearly see torsional nystagmus in the lower eye, fast component to the right, (especially when looking to the right ear) that is not typical of BPPV, and imaging would be warranted.

@GhazwanFahmi Phone the next day to see if he's better? How long had this been going on?

@GhazwanFahmi This could be PC BPPV with vagal syncope and hypoxic seizures, but I'd like to have seen torsional nystagmus and improvement with an Epley.

@VestibularFirst @Royce3457 There has never been a well documented case of the typical nystagmus of pc BPPV is seen, and it turns out to be anything other than BPPV. Vertical downward nystagmus is another story.

@MG09123 @Claps0000 @YugShankar @MedRegoncall1 Thinking the MRI is the answer to dizziness is like thinking Uber Eats is the answer to world hunger.

@MG09123 @Claps0000 @YugShankar @MedRegoncall1 I definitely think it should be taught in med school. Just like ECG is. And then taught in residency for those that see the undifferentiated dizzy patient. We need more vertigo champions. And luckily they are starting to show up.

@MG09123 @Claps0000 @YugShankar @MedRegoncall1 I agree looking for central features is important. I emphasis that in my teaching. But vestibular neuritis is still very common, and is getting MRI'ed routinely in many places. And strokes are missed. HINTS can prevent both of these problems.

@MG09123 @Claps0000 @YugShankar @MedRegoncall1 Very true. I'm creating an online course in vertigo in partner with Scott Weingart. Should be helpful to people. We need a cultural shift on how we think about vertigo.

@Claps0000 @MG09123 @YugShankar @MedRegoncall1 Curious what you think a "normal" HINTS exam is?