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Vertigo—Posterior Stroke 

Vertigo—Posterior Stroke
Vertigo—Posterior Stroke
Acute Care Casebook

Usama Qadri


This case illustrates an evidence-oriented approach to the patient with dizziness. Symptoms of dizziness, lightheadedness, nausea, and vomiting are often described under the umbrella term vestibular syndrome. Since vestibular syndrome can be caused by both less concerning peripheral causes (labyrinthitis, vestibular neuritis) as well as emergent, central causes (posterior stroke), clinicians must try to distinguish between the two. Interestingly, clinical exam findings including a thorough neurological exam with head impulse–nystagmus–tilt of skew (HINTS) testing are superior to imaging for this purpose. For the patient with high suspicion of a central process, the next step is to obtain a head computed tomography to rule out hemorrhage. If no hemorrhage is noted, then the patient should be managed with neurology for a posterior stroke and evaluated for the use of tissue plasminogen activator.

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