Neuro-Visual and Vestibular Disorders Center

When to Call 911 if You Are Dizzy

If you are dizzy and have any of the following symptoms along with your dizziness or vertigo, call 911 immediately, as these could be signs of stroke.

• New confusion or trouble speaking or understanding speech
• New slurred speech or hoarseness of voice
• New numbness or weakness of the face, arm, or leg
• New clumsiness or tremor (shaking) of the arms or legs
• New trouble seeing out of one or both eyes, or to one side
• New double vision or inability to move one or both eyes
• New unequal pupils or drooping eyelid on one side
• New inability to stand even when holding onto something firm
• Sudden severe vomiting with no known cause
• Sudden severe headache or neck pain with no known cause

Early Days

Research into vestibular and eye movement disorders in the Johns Hopkins Department of Neurology began in 1975 when David S. Zee, M.D., joined the faculty. Working with David Robinson, Ph.D., in the Department of Ophthalmology, Zee established an experimental and clinical laboratory for investigation of vestibular and eye movement disorders.

Pictured: The Robinson magnetic field search coil technique applied to humans. David Robinson is placing the coil with David Zee looking on.

The Vestibular Clinic

Shortly after, at the behest of Guy McKhann, M.D., then-chairman of the neurology department, Zee began a vestibular clinic with routine vestibular testing for patients. Because of the unique collaboration between Zee and Robinson that combined cutting-edge clinical and basic research opportunities, the vestibular program became one of the leading clinical and research training centers in the world, attracting both patients and aspiring scientists from around the globe.

Pictured: David Robinson (center) with his two clinical disciples, John Leigh (left) and David Zee (right) wearing Frenzel lenses.

Training the Next Generation

Over the next 40 years, Zee trained more than 70 postdoctoral fellows in clinical and laboratory methods, producing an enormous body of medical science and developing the next generation of neuro-vestibular clinicians and scientists. During this time, the division built extensive, longstanding collaborations with scientific partners in biomedical engineering and otolaryngology-head and neck surgery. In recent years, collaborative research projects and cross-disciplinary clinical work has extended to include physical medicine and rehabilitation, movement disorders and stroke, and others.

New Frontiers

Dr. David Newman-Toker, who trained under Dr. Zee, has been instrumental in developing the widely-known “HINTS” (Head Impulse, Nystagmus, Test of Skew), a three-step ocular motor examination battery for rapid differentiation between peripheral and central vestibular disorders in the emergency department.

We disseminated HINTS and related diagnostic techniques using novel technologies such as portable video oculography (VOG) and computer-based diagnostic decision support workups.

The Future

In the future, people who wake up feeling dizzy might first use an app to test their eye movements and answer a few basic questions: Can they self-treat at home, using only guidance from the app? Should they make an appointment with a primary care physician? Or should they immediately dial 911? Once at the clinic or the ED, a technician could have them don a pair of artificial-intelligence (AI)-enhanced video goggles for a more sophisticated algorithmic diagnosis. The toughest cases, meanwhile, would be referred to a vestibular specialist for remote diagnosis.

A Message from Dr. Zee

It is on this tremendous foundation, with new divisional leadership and first-rate junior colleagues with unique and complementary scientific and clinical skills, that we are forging ahead in new directions for both research and clinical practice. This will move our program forward as the leading center in the world for neuro-vestibular research, education and patient care.

- David S. Zee, M.D., Founding Director, Vestibular Disorders Center

A Message from Dr. Newman-Toker

I am indebted and eternally grateful to my mentor and friend of 20 years, David Zee, for his longstanding commitment to excellence in vestibular science, his invaluable contributions to the growth and development of countless trainees (among whom I count myself), and, finally, for his trust in me to take the helm of what he has built through his scientific creativity, unflagging effort, and calm leadership over 40 years.

- David Newman-Toker, M.D., Ph.D., Director, Vestibular Disorders Center