Editors' Note: Opinion and Special Articles: Remote Evaluation of Acute Vertigo: Strategies and Technological Considerations

In “Opinion and Special Articles: Remote Evaluation of Acute Vertigo: Strategies and Technological Considerations,” Green et al. discussed the telemedicine approach to a patient with acute vertigo by describing a modified version of the penlight-cover test to detect nystagmus, the alternate-cover test to check for a skew deviation and techniques to perform a virtual Dix-Hallpike maneuver and the head thrust test. Tjell agreed with the strategies described, but reported they may be challenging in a busy emergency department, and indicated a preference for 3 different assessments including the Romberg test, the horizontal smooth pursuit eye movement test, and tragal pressure. Green et al. noted that evaluation of nystagmus by smooth pursuit has pitfalls and the diagnostic value of tragal compression is unclear. They suggested that a very large multicenter international trial would be needed to clarify whether there is a difference in diagnostic accuracy between their proposed batteries or a combination of their tests.

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