Changes

==Vertigo==

==Vertigo==

*H&P: Differentiate between dizziness and lightheadedness. Peripheral and central vertigo present differently. Peripheral is positional, improves with eye fixation or closure, and central is more likely to have focal neural deficit.

*H&P: Differentiate between dizziness and lightheadedness. Peripheral and central vertigo present differently. Peripheral is positional, improves with eye fixation or closure, and central is more likely to have focal neural deficit.

*Dx: Nystagmus is rotary, unilateral, and fatigable in peripheral vertigo. In central vertigo, nystagmus is bilateral, sometimes vertical (highly specific). No headache, no CNS findings, mild ataxia, that lasts seconds (BPPV), minutes to hours ('''Ménière disease'''), more than a day (acute vestibular neuritis or labyrinthitis) or is variable duration ('''MS''', chronic otitis media, acoustic neuroma). No headache, no CNS findings, moderate-severe ataxia with (VBI-vertebrobasilar insufficiency) or without (acute vestibular neuritis or labyrinthitis) falling.

*Dx: Nystagmus is rotary, unilateral, and fatigable in peripheral vertigo. In central vertigo, nystagmus is bilateral, sometimes vertical (highly specific). No headache, no CNS findings, mild ataxia, that lasts seconds ('''BPPV'''), minutes to hours ('''Ménière disease'''), more than a day (acute vestibular neuritis or labyrinthitis) or is variable duration ('''MS''', chronic otitis media, acoustic neuroma). No headache, no CNS findings, moderate-severe ataxia with (VBI-vertebrobasilar insufficiency) or without (acute vestibular neuritis or labyrinthitis) falling.

*Tx: Treat underlying cause. For BPPV, the Epley maneuver, PT, antihistamines, benzos, and '''scopolamine''' can all help.

*Tx: Treat underlying cause. For BPPV, the Epley maneuver, PT, antihistamines, benzos, and '''scopolamine''' can all help.