Tag Archives: neurology
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 […]

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 […]

Magnetic resonance imaging brain lesions typical of multiple sclerosis.

Multiple Sclerosis Re-Examined: Essential and Emerging Clinical Concepts

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system characterized by exacerbations of neurological dysfunction due to inflammatory demyelination. Neurologic symptoms typically present in young adulthood and vary based on the site of inflammation, although weakness, sensory impairment, brainstem dysfunction, and vision loss are common. MS occurs more frequently in women […]



Headache, an almost universal human experience, is one of the most common complaints encountered in medicine and neurology. Described and categorized since antiquity, with the first classification by Aretaeus of Cappadocia, other classifications followed. The evaluation of this condition may be straightforward or challenging, and, though often benign, headache may prove to be an ominous […]

The trigeminocardiac reflex pathway diagram. 1) Trigeminal ganglion via sensory fibers of trigeminal nerve. 2) Sensory nucleus of trigeminal nerve. 3) Internuncial fibers. 4) Motor nucleus of the vagus nerve. 5) Efferent vagal nerve to the heart and stomach.

Trigeminocardiac Reflex as the Presentation of Maxillary Sinus Adenocarcinoma

A 54-year-old man with history of tobacco use presented to the Emergency Department with a few-hour history of dizziness and 2-month history of intermittent right jaw pain. His blood pressure was 68/48 mm Hg, heart rate was 55 beats per minute, and oxygen saturation was 85% on room air. Physical examination was notable for a […]