Welcome to Emergency Medicine Cases.com. I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.

First off, in our highlights of the Emergency Medicine Update Conference 2014, we have with us Dr. Stuart Swarden.

Dr. Swarden is the Vice Chair for Education and the Residency Program Director in the Department of Emergency Medicine at LA County USC Medical Center.

He's an associate professor of clinical emergency medicine at USC's Keck School of Medicine of the

University. All right, so we're going to talk about something scary, right? Vertigo. Now the whole

thing about vertigo is what concerned about missing a stroke, and those

strokes obviously are in the brain stem, okay? Probably about less than 25% of the brain is the

area where all the important stuff is in terms of the cranial nerves that we're talking about.

And so that works to our advantage, of course, because it's very hard to get a central eight nerve without getting other things in the neighborhood. It's very hard to get an eight without getting something around it. Okay? Now, is it isolated? Is the question here? If it's isolated vertigo, it's much less likely to be something serious. Okay, so everyone knows that. Now, if you have more than one thing on the central side, you're automatically talking about central vertigo, MRI, admit, that type of stuff. The other side, the peripheral vertigo, the only time when you actually can make a diagnosis of peripheral

vertigo when you have more than one feature is this, when you have vertigo, tenetis, and

hearing loss.

What's that?

That's Menyar's disease, right?

So outside of that, if vertigo is not isolated, then forget it, right?

It's beyond us. It's going to be something we're going to have to consult for. We're going to get an MRI, that type of thing. And there's something interesting that's happened in the past couple of years, actually, is we used to say if they got the vertigo and the hearing loss together, that's peripheral. Unbelievably, in the past three years, several articles have come out that have actually debunk that. So outside of the actual meniars triad of tenetis and vertigo and hearing loss,

if it's not isolated, it's central until proven otherwise.

A lot of people miss strokes.

It's very hard to practice with never missing a posterior faust foster stroke in your whole career.

But if you look back at the charts, you see the same old crap every time.

Cranial nerves, 2 through 12 normal.

Okay, you can't write stuff like that because people say,

well, did you test cranial nerve number seven?

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