Patients with central vertigo should be evaluated for cerebellar stroke or hemorrhage
○ Next step in management: noncontrast CT of head
● Epley: otolith repositioning maneuver → treats
BPPV
Radiculopathy
● Multiple nerve roots compressed → radiating pain
○ Peripheral neuropathy: 1...
, ● Patients with central vertigo should be evaluated for cerebellar stroke or hemorrhage
○ Next step in management: noncontrast CT of head
● Epley: otolith repositioning maneuver → treats
BPPV
Radiculopathy
● Multiple nerve roots compressed → radiating pain
○ Peripheral neuropathy: 1 nerve root affected,
stocking glove distribution
● Common cause is herniated disc: annulus fibrosus,
nucleus pulposus, pain exacerbated by
coughing/sneezing
○ Straight leg raise: highly sensitive for disc
herniation, shooting pain
● Common cause is spondylosis: degenerative
condition of spine marked by ostephyte formation
● Other causes: infection, tumor, infarct, demyelination
● LMN, unilateral
● Weakness/numbness/paresthesias/pain in
myotomal (reflexes affected) and dermatomal
distribution
● Conservative management: NSAIDs,
acetaminophen
● Self-limiting: often don’t need neuroimaging,
MRI is done if high risk features are present
Cervical spondylotic myelopathy
● Compression of cervical spinal cord by
degenerated vertebral bodies, facet joints,
herniated discs
Cauda equina syndrome
● Neuro emergency
● Compression of spinal nerve roots
L2 and below
● Severe radicular pain, impaired
motor/sensory/reflex activity in
lower extremities, bowel and
bladder/sexual dysfunction, saddle
anesthesia
● May occur secondary to metastatic
spread of cancer through CSF
● LMN symptoms only
○ Conus medullaris syndrome: UMN/LMN symptoms
● Management: glucocorticoids and surgical correction (lumbar laminectomy)
Epidural spinal cord compression
● Back pain, UMN signs
● Urinary/bowel incontinence, LE weakness, loss of
balance, complete paralysis of LE
● History of malignancy
● First step if symptomatic: IV glucocorticoids reduce
edema/inflammation, followed by management
○ Urgent MRI and neurosurgical
decompression (laminectomy), antibiotics
○ LP contraindicated due to risk of inoculating
CSF
● Spinal epidural abscess
○ Commonly due to S. aureus
○ Fever, AMS, meningismus, back pain, tenderness to palpation,
weakness/numbness/paralysis below the affected spinal level
○ Tx: broad spectrum antibiotics + surgical drainage
Spinal stenosis
● Narrowing of spinal canal → compression of nerve roots/spinal cord
○ May present with symptoms of radiculopathy (back pain, radiation, sensory/motor
weakness)
● Spinal flexion (leaning forward) relieves pain
● Diagnostic: XR, then MRI of spine
● Tx: NSAIDs, physical therapy, surgery
2
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