Abstract:
:Dizziness is a common chief complaint with an extensive differential diagnosis that includes both benign and serious conditions. Physicians must distinguish the majority of patients who suffer from self-limiting conditions from those with serious illnesses that require acute treatment. The preferred approach to the diagnosis of an acutely dizzy patient emphasizes different aspects of the history to guide a focused physical examination, with the goal of differentiating benign peripheral vestibular conditions from dangerous posterior circulation strokes. Currently, misdiagnoses are frequent and diagnostic testing costs are high. This partly relates to use of an outdated diagnostic paradigm. This commonly used traditional approach relies on dizziness "symptom quality" or "type" (vertigo, presyncope, disequilibrium) to guide inquiry. It does not distinguish benign from dangerous causes and is inconsistent with current best evidence. A better approach categorizes patients into three groups based on timing and triggers. Each category has its own differential diagnosis and targeted bedside approach: (1) acute vestibular syndrome, where bedside physical examination differentiates vestibular neuritis from stroke; (2) spontaneous episodic vestibular syndrome, where associated symptoms help differentiate vestibular migraine from transient ischemic attack; and (3) triggered episodic vestibular syndrome, where the Dix-Hallpike and supine roll test help differentiate benign paroxysmal positional vertigo from posterior fossa structural lesions. The "timing and triggers" diagnostic approach for the acutely dizzy derives from current best evidence and offers the potential to reduce misdiagnosis while simultaneously decreasing diagnostic test overuse, unnecessary hospitalization, and incorrect treatments.
journal_name
Semin Neuroljournal_title
Seminars in neurologyauthors
Gurley KL,Edlow JAdoi
10.1055/s-0038-1676857subject
Has Abstractpub_date
2019-02-01 00:00:00pages
27-40issue
1eissn
0271-8235issn
1098-9021journal_volume
39pub_type
杂志文章,评审abstract::Clinical guidelines for the determination of brain death in children were first published in 1987. These guidelines were revised in 2011 under the auspices of the Society of Critical Care Medicine, the American Academy of Pediatrics, and the Child Neurology Society, and provide the minimum standards that must be satis...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0035-1547540
更新日期:2015-04-01 00:00:00
abstract::Three-quarters of all strokes are managed outside of academic medical centers, making optimization of stroke care in the community setting a central part of minimizing the disability from stroke. In addition, the care of stroke patients crosses multiple different components of the health care system and requires a mul...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-2005-923528
更新日期:2005-12-01 00:00:00
abstract::Both general neurologists and neurologists with a broad spectrum of subspecialty interests are often asked to evaluate patients with disorders of the spinal cord. Over the past decade, there have been significant advances in our understanding of a wide spectrum of immune-mediated, infectious, metabolic, hereditary, pa...
journal_title:Seminars in neurology
pub_type: 杂志文章
doi:10.1055/s-0029-1244993
更新日期:2010-02-01 00:00:00
abstract::Parkinson's disease (PD) is a significant neurodegenerative disease of the elderly, affecting 1 to 2% of those over 60 years of age. The disorder is characterized by resting tremor, bradykinesia, rigidity, postural instability, and pathologically by alpha-synuclein-positive Lewy bodies. For most, the etiology is unkno...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-2006-951621
更新日期:2006-11-01 00:00:00
abstract::Listeria monocytogenes infection of the central nervous system is often not recognized and treated appropriately in the crucial early stages of the disease. Most consider patients with underlying disease or immunocompromised states to be at risk, although healthy individuals may present with a neurologic syndrome caus...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-2000-9398
更新日期:2000-01-01 00:00:00
abstract::Dopamine agonists provide an effective means of treating early, middle, and late stages of Parkinson's disease. This article outlines the advantages and disadvantages of dopamine agonists as compared with levodopa therapy. The features and costs of the four Food and Drug Administration-approved agonists (bromocriptine...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-2001-13114
更新日期:2001-01-01 00:00:00
abstract::A recent development in the evaluation of peripheral neuropathy patients has been the identification of autoantibodies directed against various peripheral nerve antigens. For some conditions, assay for the antibodies can be very helpful in confirming a diagnosis. In others, an antibody may be associated with clinical ...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-2008-1040864
更新日期:1998-01-01 00:00:00
abstract::Osteoporosis is a debilitating disease that occurs in epidemic proportions in Western societies and has a large economic impact. Percutaneous vertebroplasty is successful in alleviating subacute and chronic pain caused by osteoporotic compression fractures and pathological vertebral fractures from tumor infiltration. ...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-2002-36538
更新日期:2002-06-01 00:00:00
abstract::The clinical history and neurological examination provide the most important data on which the diagnosis of autoimmune myasthenia gravis (MG) is based. MG produces symptomatic weakness that predominates in certain muscle groups and typically fluctuates in response to effort and rest. The diagnosis of MG therefore depe...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-2004-829594
更新日期:2004-03-01 00:00:00
abstract::Cognitive complaints are common in any adult neurology practice, and may present in a variety of ways other than classic "memory loss." In this article, the author reviews a simple approach to a symptom-based differential diagnosis, including recognition of impairment in several key cognitive domains as well as associ...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0031-1271314
更新日期:2011-02-01 00:00:00
abstract::Treatment of dementias represents an important but relatively neglected part of neurological care of the elderly population. Individual therapeutic interventions may make only small changes to the quality of life of individuals afflicted with dementia, but when used in combination these interventions synergize and can...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0039-1683408
更新日期:2019-04-01 00:00:00
abstract::Neurotoxic venoms are common among tropical marine creatures, which have specialized apparatuses for delivery of the venoms. These include jellyfish and anemones, venomous cone snails, venomous fish, stingrays, sea snakes, and venomous octopuses. Numerous toxic neuropeptides are found within these venoms, and some can...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-2005-917664
更新日期:2005-09-01 00:00:00
abstract::One of the most prolific chemical and anatomical imaging techniques of recent decades, magnetic resonance imaging (MRI), includes the ability to noninvasively assess neurochemical changes with magnetic resonance spectroscopy (MRS). Practical concerns are paramount in applying MRS, such as what the manufacturer provide...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0028-1083685
更新日期:2008-09-01 00:00:00
abstract::Psychogenic (nonepileptic) seizures are among the most common and serious of all psychogenic neurological disorders. They account for approximately 20% of all intractable seizure disorders referred to comprehensive epilepsy centers and present with a reported annual incidence of approximately 4% that of true epilepsy....
journal_title:Seminars in neurology
pub_type: 杂志文章
doi:10.1055/s-2006-945520
更新日期:2006-07-01 00:00:00
abstract::Myelopathy refers to a spinal cord disorder that presents with motor and/or sensory deficits. Infectious agents that cause myelopathy do so by either direct infection of neural structures (e.g., polio), a parainfectious mechanism (with a presumed autoimmune pathogenesis), or as a result of involvement of structures ad...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0032-1322588
更新日期:2012-04-01 00:00:00
abstract::Obstructive sleep apnea (OSA) is a very common condition in patients with stroke and is found in over half of stroke patients. There is a complex relationship between OSA and stroke, attributable to shared risk factors. There are numerous mechanisms by which OSA may contribute to increased stroke risk, including promo...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-2006-933315
更新日期:2006-02-01 00:00:00
abstract::Accurate outcome prognostication is critical to the management of patients with primary or spontaneous intracerebral hemorrhage (ICH). Prognostication may guide the decision to pursue aggressive acute management or to plan proper goals of care for patients who will likely suffer long-term severe disability. In particu...
journal_title:Seminars in neurology
pub_type: 杂志文章
doi:10.1055/s-0036-1581992
更新日期:2016-06-01 00:00:00
abstract::Headaches are a common complaint for most women during their lifetime, including gestation and puerperium. Tension-type headaches and migraine flare-ups are the most common headache complications after delivery, but the differential diagnosis of postpartum headache is broad. The clinician must distinguish common heada...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0031-1293537
更新日期:2011-09-01 00:00:00
abstract::In addition to sharing several clinical, pathologic, and molecular characteristics, many neurodegenerative disorders show extensive familial histories suggesting a substantial contribution of genetic factors to disease causation and progression. In this review, the authors provide overviews of the status of current ge...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0031-1299791
更新日期:2011-11-01 00:00:00
abstract::Improved disease control is critical for enhancing the lives of those living with multiple sclerosis. With specific immunologic targets, monoclonal antibody (mAb) treatments are highly effective options for relapsing forms of multiple sclerosis. The mechanism, efficacy, and current safety profiles are detailed for the...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0036-1579695
更新日期:2016-04-01 00:00:00
abstract::Parkinsonism is a clinical syndrome, which is characterized by bradykinesia, rigidity, rest tremor, and postural instability. Idiopathic Parkinson disease (PD) is the most common cause of this syndrome, though there are several other important etiologies that must be considered. These include the atypical Parkinsonian...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0036-1585097
更新日期:2016-08-01 00:00:00
abstract::Vaccines have undoubtedly been a medical milestone, preventing immeasurable morbidity and mortality from infectious diseases worldwide. Modern vaccines have tremendously reduced the global impact of numerous infections; they have succeeded in eliminating smallpox completely. However, the nature by which vaccines confe...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0031-1287655
更新日期:2011-07-01 00:00:00
abstract::Mitochondrial diseases are multiorgan system disorders and the brain is the most commonly affected organ. The high-energy requirement of the brain leaves it vulnerable to energy failure. All components of the neuraxis including muscle, the neuromuscular junction, peripheral nerve, spinal cord, and brain can be affecte...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0034-1386770
更新日期:2014-07-01 00:00:00
abstract::Dizziness, vertigo, and imbalance are likely the most common presenting complaints among patients 75 years and older in office practices. Although the cause of falls among the aging population is multifactorial, several studies have implicated senescence of the vestibular periphery. It is imperative that clinicians co...
journal_title:Seminars in neurology
pub_type: 杂志文章
doi:10.1055/s-0029-1241039
更新日期:2009-11-01 00:00:00
abstract::Carotid endarterectomy is an established surgical procedure to prevent stroke. The indications, preoperative evaluation, surgical timing, technical details, complications, and special circumstances for the use of this operation are reviewed. Future developments in the surgical reconstruction of the extracranial caroti...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-2008-1040902
更新日期:1998-01-01 00:00:00
abstract::Evaluation of patients with cranial neuropathies requires an understanding of brainstem anatomy and nerve pathways. Advances in neuroimaging, particularly high spatial resolution magnetic resonance imaging (MRI), have enabled visualization of these tiny structures and their related pathology. This review provides an a...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0032-1331807
更新日期:2012-09-01 00:00:00
abstract::The fields of neurology and psychiatry were originally practiced as a unitary model. As the fields dichotomized patients into "organic" and "functional," patients with medically unexplained symptoms fell between the borderlands. Despite their significant prevalence, somatoform disorders (SDs) are grossly under-recogni...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0029-1223875
更新日期:2009-07-01 00:00:00
abstract::Cancer therapy can cause several neurotoxic syndromes that are associated with distinct findings on cranial imaging. With the use of more aggressive and combined treatment modalities in oncology and prolonged overall patient survival, neurotoxicity has been reported with increasing frequency in patients with brain can...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-0032-1331817
更新日期:2012-09-01 00:00:00
abstract::The PPS is now a well-recognized entity encompassing the late manifestations that occur because of previous poliomyelitis. Common signs and symptoms include fatigue, cold intolerance, joint deteriorations with pain, and prominent neurologic problems that include new weakness, muscle pain, atrophy, respiratory insuffic...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-2008-1041136
更新日期:1993-09-01 00:00:00
abstract::Alzheimer's disease (AD) is the most common form of dementia in elderly individuals. Although the diagnosis of AD requires pathological confirmation, several common clinical features of AD have been identified. These include insidious onset, gradual progression, medial temporal atrophy, temporoparietal hypoperfusion, ...
journal_title:Seminars in neurology
pub_type: 杂志文章,评审
doi:10.1055/s-2000-13177
更新日期:2000-01-01 00:00:00