EMCrit Podcast EMCrit Podcast 33 – Diagnosis of Posterior Stroke
Oct 9, 2010
A focused guide to spotting cerebellar strokes that masquerade as isolated vertigo. Clear differences between episodic and continuous dizziness are outlined. The limits of standard neuro screening are exposed. Practical bedside maneuvers including the HINTS components and signs like ataxia and skew deviation are highlighted.
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Risk Of Missing Cerebellar Stroke
- Scott recounts that missing cerebellar strokes and discharging patients with meclizine can have serious consequences due to limited posterior fossa space.
- He uses this to emphasize careful evaluation of vertigo patients instead of reflexively labeling them benign.
Differentiate Episodic From Persistent Vertigo
- Differentiate intermittent BPPV from continuous vertigo by history: BPPV is episodic with head movement triggers and symptom-free intervals.
- Treat persistent continuous vertigo as acute peripheral vestibulopathy (APV) or possible cerebellar stroke and evaluate further.
Standard Neuro Screen May Miss Posterior Stroke
- Standard ED neurologic screening can miss cerebellar stroke presenting as isolated vertigo unless you perform targeted vestibular testing.
- Key red flags include significant gait or truncal ataxia and inability to sit or walk without assistance.