Opinion and Special Articles: Remote Evaluation of Acute Vertigo: Strategies and Technological Considerations

Kemar E Green; Jacob M Pogson; Jorge Otero-Millan; Daniel R Gold; Nana Tevzadze; Ali S Saber Tehrani; David S Zee; David E Newman-Toker; Amir Kheradmand

doi:10.1212/WNL.0000000000010980

Opinion and Special Articles: Remote Evaluation of Acute Vertigo: Strategies and Technological Considerations

Neurology. 2021 Jan 5;96(1):34-38. doi: 10.1212/WNL.0000000000010980. Epub 2020 Oct 1.

Authors

Kemar E Green¹, Jacob M Pogson², Jorge Otero-Millan², Daniel R Gold², Nana Tevzadze², Ali S Saber Tehrani², David S Zee², David E Newman-Toker², Amir Kheradmand²

Affiliations

¹ From the Departments of Neurology (K.E.G., J.M.P., J.O.-M., D.R.G., N.T., A.S.S.T., D.S.Z., D.E.N.-T., A.K.), Otolaryngology-Head and Neck Surgery (D.R.G., D.S.Z., D.E.N.-T., A.K.), Ophthalmology (D.R.G., D.S.Z., D.E.N.-T.), Emergency Medicine (D.R.G.), Neurosurgery & Medicine (D.R.G.), and Neuroscience (D.S.Z.), The Johns Hopkins University School of Medicine, Baltimore, MD; and School of Optometry (J.O.-M.), University of California, Berkeley. kgreen66@jhmi.edu.
² From the Departments of Neurology (K.E.G., J.M.P., J.O.-M., D.R.G., N.T., A.S.S.T., D.S.Z., D.E.N.-T., A.K.), Otolaryngology-Head and Neck Surgery (D.R.G., D.S.Z., D.E.N.-T., A.K.), Ophthalmology (D.R.G., D.S.Z., D.E.N.-T.), Emergency Medicine (D.R.G.), Neurosurgery & Medicine (D.R.G.), and Neuroscience (D.S.Z.), The Johns Hopkins University School of Medicine, Baltimore, MD; and School of Optometry (J.O.-M.), University of California, Berkeley.

Abstract

Patients with acute vestibular disorders are often a diagnostic challenge for neurologists, especially when the evaluation must be conducted remotely. The clinical dilemma remains: Does the patient have a benign peripheral inner ear problem or a worrisome central vestibular disorder, such as a stroke? The use of a focused history and the virtual HINTS (head impulse test, nystagmus evaluation, and test of skew) examination are key steps towards correctly diagnosing and triaging the acute vertiginous patient. When looking for signs of vestibulo-ocular dysfunction, there are important technological and practical considerations for an effective clinical interpretation.

MeSH terms

Humans
Telemedicine / methods*
Vertigo / diagnosis*