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A modified Epley maneuver for the treatment of left posterior semicircular canal benign paroxysmal positional vertigo. The head is turned 45° toward the left (A); then the patient reclines back with the head still turned left (B), and this position is maintained for approximately 30 seconds. If nystagmus is observed, the patient turns the head 90° toward the right side (C) while maintaining neck extension. The head-hanging-right position is then maintained for approximately 30 seconds. Next, the patient is turned further toward the right, into a side-lying position, such that the head is turned in the same direction, 90° beyond its last position; the nose should then be pointing in a direction that is about halfway between parallel and perpendicular to the floor (not shown). After approximately 30 seconds, the patient sits up. For the treatment of the right posterior canal variant, this procedure is followed with the modification of exchanging the words right and left. Treatments of the horizontal and anterior canal variants are outside the scope of this review.


  Dizziness is common, as reflected by the cost of assessing dizziness in U.S. emergency rooms, which reportedly exceeds $4 billion per year.1, 2 For many patients, the pathophysiology of dizziness will not be fully demonstrable by diagnostic tests. However, a systematic clinical approach allows for the identification of common forms of dizziness. Recognizing common patterns of […]

Spectrum of cerebral injuries from atrial fibrillation and atrial fibrillation management. (A) Large right middle cerebral artery territorial infarction on diffusion-weighted magnetic resonance imaging (MRI; arrow). (B) Ischemic infarction in multiple vascular territories on diffusion-weighted MRI. Left frontal lobe (blue arrow), right occipital lobe (red arrow), left occipital lobe (yellow arrow) are involved in this image on cerebral MRI (arrows). (C) Multiple microbleeds (white arrows) along with a larger right frontal subcortical hemorrhage (blue arrow) on brain MRI with susceptibility images. (D) Large high convexity right frontal hematoma with surrounding vasogenic edema on noncontrast computed tomography of the head (arrow).

Dementia and Atrial Fibrillation: Pathophysiological Mechanisms and Therapeutic Implications

Atrial fibrillation increases the risk of stroke by a factor of four- to fivefold, and dementia is a common consequence of stroke. However, atrial fibrillation has been associated with cognitive impairment and dementia, even in patients without prior overt stroke. Nonischemic mechanisms include cerebral hypoperfusion, vascular inflammation, brain atrophy, genetic factors, and shared risk factors […]


Tramadol: Understanding the Risk of Serotonin Syndrome and Seizures

Tramadol is commonly prescribed for pain control because it presents a lower risk for addiction and respiratory depression compared to other opioids. However, tramadol’s serotonin and norepinephrine reuptake inhibitory effects result in a unique adverse effect profile. Two such adverse events are serotonin syndrome and seizures. The prevalence of tramadol-induced serotonin syndrome and seizures is […]

Magnetic resonance imaging brain scan with contrast. (A) Axial view showing (arrow) transverse and sigmoid sinus venous thrombosis. (B) Axial view showing (arrow) left ophthalmic vein thrombosis. (C) Sagittal view showing (arrow) left ophthalmic vein thrombosis. (D) Axial view showing (arrow) focal perichiasmatic enhancement of the left optic nerve.

Lesson Learned Through a Case of Pneumococcal Meningitis: Sometimes Doing Less Is More Harmful

Pneumococcal meningitis is commonly associated with intracranial complications. We present a case of pneumococcal meningitis leading to partial loss of vision in the left eye secondary to vascular complications. A 62-year-old African American female with a past medical history of breast cancer and hypothyroidism presented with complaints of altered mental status, neck pain, headache, and […]

doctor uses tablet with patient

Twenty-Five-Year (1986-2011) Trends in the Incidence and Death Rates of Stroke Complicating Acute Myocardial Infarction

The occurrence of a stroke after an acute myocardial infarction is associated with increased morbidity and mortality rates. However, limited data are available, particularly from a population-based perspective, about recent trends in the incidence and mortality rates associated with stroke complicating an acute myocardial infarction. The purpose of this study was to examine 25-year trends […]

young female doctor examines x-ray

From Mechanical to Chemical: A Case of Diabetes Insipidus Induced by Concussive Brain Injury

Diabetes insipidus is a rare disorder of water-electrolyte balance characterized by either absolute (central) or functional (nephrogenic) deficiency of vasopressin or antidiuretic hormone.1 Central diabetes insipidus is a recognized complication of traumatic brain injury; however, those patients are much sicker and have other symptoms from the trauma as well.2 We present a case of complete central diabetes […]

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