Approach to Dizziness Following Traumatic Brain Injury
Friday, November 16th  13:30-13:50
Speaker: Dr. John Rutka, Professor Department of Otolaryngology-Head and Neck Surgery, University of Toronto, University Health Network
Headaches, neuropsychological/neurocognitive complaints and dizziness are common findings post head injury.-- This presentation will concentrate on a tailored approach to the history, physical examination and then necessary laboratory inner ear investigations required for the management of the dizzy patient post head injury. Special attention will be focussed on the clinical neurological provoking tests and management of benign position paroxysmal vertigo (BPPV) which is the most common organic peripheral vestibular disorder identified post head injury. Physical therapy manoeuvres for the management of BPPV are demonstrated. Surgical treatment for those with incapacitating BPPV recalcitrant to medical management and for canal dehiscent syndromes post trauma are demonstrated additionally-- Unique findings from a prospective series of > 4,000 head injured workers with "dizziness" referred from the Workplace Safety and Insurance Board (WSIB) since 1988 are presented. The mechanism of injury ( fall, contusion, explosion etc), class of injury (blunt, penetrating, accelerating/decelerating etc), its severity (minor, closed, closed with skull # etc), whether there was an associated loss of consciousness, imaging findings etc have been studied. Overall approximately 20% were identified to have neurotological abnormalities in this series. The common diagnoses made in those with post head injury dizziness is noted.-- There were quite significant differences in the presence of organic pathology depending on the profession involved. Controversial areas such as the development of Meniere's disease post trauma/differing resilience levels in certain professionals, assault in the workplace, the most dangerous jobs in Ontario etc are discussed.

Objectives: At the end of the session, the participants will be able to...
-- 1. Determine the important features necessary for the history and physical examination of the ""dizzy"" patient.
-- 2. List the necessary vestibular function tests for investigation of the dizzy patient.
-- 3. Compare and contrast different physical therapy manoeuvres for the treatment of BPPV.
-- 4. Compare the resilience of different professions with dizziness following head injury.
-- 5. Summarize the common causes for dizziness post head injury.
-- 6. Explain features that suggest a peripheral vestibular cause for an individual's post head injury dizziness

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* 1. Please rate the session:

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The session met my expectations.
The audio visuals and related materials were well chosen and of good quality.
There was adequate time for questions/discussion and evaluation.
I gained new knowledge and skills.
The session was free from commercial bias.

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* 2. Please rate the speaker: John Rutka

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The speaker demonstrated thorough knowledge about the topic and established a good rapport with the audience.
The objectives were adequately met and the speaker stimulated enthusiasm about the topic.
The speaker was well informed, spoke clearly, managed time well and answered questions satisfactorily (an overall assessment is requested).
The facilitator was prepared, managed time well and encouraged participation and evaluation.

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* 3. As a result of attending this session I am planning to:  (Check all that apply)

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* 4. Other comments/suggestions/topics for future meetings:

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