A nice overview. However the case management needs some clarification. The HNTS exam is NOT the first line of defence against missing a dizzy stroke. The best way to not miss a dizzy patient who is having a stroke is to look for features that would bring the diagnosis of vestibular neuritis in doubt. Headache can be associated with cerebellar ischemic stroke or hemorrhage. Neck pain can be associated with vertebral artery dissection. New focal weakness or paresthesia, diplopia, dysarthria, dysmetria, dysphagia or dysphonia are also concerning for posterior circulation stroke. In ability to walk unaided is rare in vestibular neuritis, but common in stroke. Only after these features have been carefully looked for and found to be absent should the HINTS exam be applied. Given his history of a headache coming on with his dizziness, a CT head (or CT head plus CT angio) would be required before considering TPA. Whether a patient with isolated AVS, no other neuro findings with a overall HINTS central result should get TPA is not a question that has been answered by clinical studies yet.
A nice overview. However the case management needs some clarification. The HNTS exam is NOT the first line of defence against missing a dizzy stroke.
The best way to not miss a dizzy patient who is having a stroke is to look for features that would bring the diagnosis of vestibular neuritis in doubt. Headache can be associated with cerebellar ischemic stroke or hemorrhage. Neck pain can be associated with vertebral artery dissection.
New focal weakness or paresthesia, diplopia, dysarthria, dysmetria, dysphagia or dysphonia are also concerning for posterior circulation stroke.
In ability to walk unaided is rare in vestibular neuritis, but common in stroke.
Only after these features have been carefully looked for and found to be absent should the HINTS exam be applied.
Given his history of a headache coming on with his dizziness, a CT head (or CT head plus CT angio) would be required before considering TPA.
Whether a patient with isolated AVS, no other neuro findings with a overall HINTS central result should get TPA is not a question that has been answered by clinical studies yet.
Thank you 🙏
Exactly, TPA should never be administered before a non con CT rules out a bleed😮
DWI MRI shoudnt be first than tPA? what if the couse was bleeding? or it is discarted by the symptoms