Відео

The secret is in waiting 2 minutes b4 the next movement for the Epley to really work!! Dr. Johns after 4 months I can only say Thank you a million times!!!

Doc, why the vertical vor and torsional arent frequently tested like the horizontal? And one more question if you let me, why the torsional vor has different behavior depending on the speed of head tilt. For example, if the head is tilted very fast to the shoulder, the eyes will have many quick torsional movements to the same side of head tilt, but if the head is move very slowly to the same position there are way less quick torsional eye movements or even none quick torsional eye movements. Thanks

Dr. Johns, You are surely one of the best teachers I have ever come across. Congratulations! And, thanks for your wonderful teaching videos.

Brilliant, really useful video Doctor , thank you

I found this video the other day. I've had what I've described as ocular migraines stemming from light sensitivity since 1993. I began having short vertigo spells in 2009. In 2010 I had a major spell that left me spinning hard for 15 minutes straight. From there I would have them come and go in short spells. First week of January 2012 I had a spell that lasted a month straight. From there I would have spells with some frequency but ultimately tapering off. I have struggled to get a proper diagnosis and struggled even more so for my doctors to take me serious. Since 2012 spells come and go but what I am left with on a day to day basis is loopiness and a constant dull pressure in my head which makes thinking clearly difficult. I realized that windy or humid conditions flare up the instability in my head which is incredibly frustrating. I have experienced a bit of relief through acupuncture but not much else. Seeing your patient in this video is the first time I have felt as if im not alone. I am stuck in a state of caution and I would like to break this cycle. I will read more from you and look at newer videos from you but unfortunately the rest of the medical world is not moving at the same speed when it comes to newer ways of exploring vertigo.

Thank you! This video is easy to understand and informative.

Law and order reference, Love to see it haha Thanks for the awesome/educational videos Dr. Peter Johns! Salutations from Denver, Colorado!

My only difference is that it sarted in my hips first.

I have learned more from u than neurologists, thank u dr!

incredible video. doc, I have a question, is it normal to have little saccades when performing slow vor (moving head slowly left and right) looking to small targets far away?

Thanks for the video! Came here after a UWorld question on cerebellar stroke. I'm surprised anyone would emphasize the insidious nature of central vertigo w/o emphasizing the important exception of the acute onset of stroke.

could you please explain why peripheral nystagmus intensifies when looking in the direction of the fast phase/the healthy ear??

amazing!!! especially the explanatin of why the rapid phase is towards the healthy ear, thank you!!

Amazing video, thank you!

very very helpful for my ENT case presentation this week! thank you doctor

Very nice and that makes significant change in my daily clinical practice about dizzy patients. Thanks so much.

Have you heard of Aimovig causing a new symptom of vertigo? Or if it does?

What if you have congenital nystagmus? 😭

This was very helpful and the kid made it cute. One thing kind of hung us up--you say 90 degrees and my husband and I are both thinking, "Isn't that 180 degrees?" Is it us?

Very usefull,thanks alot

thanks alot

Does this manoeuvre need to be repeated or should it work first time? Thanks 😊

Thank you Dr. Johns, this is a very helpful content

I really enjoy your vertigo videos and infact I recommend every doctor to watch your videos on this extremely topic. Just one thing that I think is not right: I note that You are advocating impulsing the head from right or left lateral to midline instead of jerking it laterally from midline primary position. This must be your own or someone else’s modification, because I have not read this method of Head Inpulse in any neuro text including Adam and Victor’s and Blumefeld’s Neuroanatomy through Clinical cases. Professor Haymalgayi who described this test has also not described it and he is the guy here in Australia who does all the advances testing in spinning chair and much more when no one can figure out what is making the patient dizzy. And I dont conceive how test ever will or ever could be validated the way it is being suggested here. There are simple and very obvious anatomical and physiological reasons why it cant be validated this way: the premise and foundation for the head impulse testing is the anatomical and physiological fact that in primary position the gaze centring mechanisms on right and left are firing equally which is necessary to keep the gaze in primary position. This ‘centring tendency’ is the default position and action of the brain mechanisms that mediate it. Lateral head position with fixing the eye on a point straight ahead is a deviation and a departure from the default state. Once you move the head to right or left those impulses have changed in their amplitude and firing frequencies to keep the eyes fixated straight forward. Moving the head from right or left lateral to the midline is not the same as jerking the head to right or left lateral because neuronal impulses have to change to make adjustments. When you move the head away from that specifically defined primary gaze position, then you have changed the afferent impulses firing rates and amplitudes of the brain mechanisms and impulses that mediate the VOR hence and keep the eyes centred, thus altering the validity of the test. So we can not just swap the test around(even if it is with the noble intentions of making it more comfortable for the patient). The primary position for VOR and semicricular canals is the primary gaze position which is head horizontal in neutral position and looking straight forward as in anatomical postion and the eyes gazing straight forward. But I look forward to be corrected and educated by such a learned and highly esteemed colleague like yourself. If you have any clinical references I look forward to reading them and the primary references they mention. Regards A 26th year medical student.

19:20 are you saying that if nystagmus is left beating then in vestibular neuritis head impulse will also be when head is impulses to the left. That is opposite to what you have been saying earlier in this video (and many other videos). If his left vestibular nerve is affected, his HI test would have catchup saccade when his head is turned impulsed to the RIGHT, not left side. Or did misunderstood something? Would appreciate if you can clarify please. Thanks.

Awesome video!!! But I want to know how to diference the central problem when the pacient have acute vertigo but not nystagmus. Does anyone have any material?

previosly healthy patient admitted with 3 days of acute vestibular syndrome. nausea and vomiting x several. ate and drank badly. appetiteless. overall neurological status was unremarkable. the general condition was stable in the supine position, although a little weak. no dysatria, dysphagia, dysmetria, diplopia. HINST with unidirectional right nystagmus. neg test of skew, positive head impulses test, no auditory symptoms. the only thing that stood out was that the patient could not stand without support. The patient was assessed as vestibular neuritis, and since several days has passed, no ct brain was ordered. Admitted for observation and following the status. during the next day the general condition worsened and CT brain showed cerebellum infarction. The question is, how does the ability to walk differ between vestibular neuritis and posterior infarction? I know posterior infarct is unable to walk unaided, but so is vestibular neuritis???

Hi Dr. Johns, I'm a novice medical student, so please forgive me for the very basic question, but I'm wondering how we should interpret gaze-evoked nystagmus (similar to what you mention at around 29 minute mark of the video) in a patient with continuous vertigo, but no spontaneous nystagmus (I.e. when at rest looking straight ahead). Should we also not do a HINTS exam on these patients? Based on the phrasing that we should only be doing HINTS exams on pts with acute vestibular syndrome and spontaneous nystagmus, my assumption is that the answer is NO, but just want to clarify. Thank you.

Thank you so much sir, that was very crisp to the point and informative at the same time

الف رحمة على روح والديك

Very good video...precise and easy to understand

Can you please expand on those with constant dizziness without any nystagmus? What testing do you do in office?

Deeply useful, thanks.

Brilliant.

Dr. Johns, thank you for the video. I am undergoing my emergency medicine postings and attending my ENT (as we refer to the subject of Otolaryngology in India) classes at the same time, this video quite comprehensively integrated the concepts for me. Grateful to you for sharing your knowledge and experience with the young buds.

This is a great video. Simple, to the point and with EXCELLENT patient videos.

WoW. Looking at your videos list...Its not hard to see what you are obsessed with ..😊. Cheers.

BEST EVER NOW APPROACG FOR VERTIGO SO CLEAR AS BEFORE WAS CONSUDED LITTLE BIT. THANK YOU.

I see a lot of comments on good video but no mention as to the successful treatment of vm as many of us have been on all kinds of meds with no relief

Beautifully explained. Thank you

perfect! thx very much

Thx very much! from Chile

great explanation. Much appreciated sir!

Thank you this helps I get vertigo all the time

Thanks!!!

Slappin' info, my beautiful medical guy! Keep up the good work here on youtube. Most vertigo videos are pretty superficial and you can't really apply the skills at all afterwards because the information is too vague/inconsistent. Ex: central vertigo ALWAYS has a slow onset, peripheral ALWAYS has a sudden onset. How about stroke? So many times strokes are overlooked, people don't even look for them.

Thanks for your videos. I would like to suggest that the HIT is useful to do on a patient without gaze nystagmus to assess for unilateral hypofunction. This is not in context of the ED environment where one might be ruling in or out life-threatening etiology, but is helpful in a physical therapy environment to create an exercise program to strengthen the overall system and decrease falls risk. (Herdman, 2011)

Finally the full explaintion

I'm at a crossroads. The first ENT diagnosed me with VM and the 2nd tentatively with Autoimmune inner ear disease based on very slight hearing improvement on prednisone. (But wasnt convincing enough) The symptoms were: occasional episodes of intense vertigo with loud tinnitus and muffled hearing lasting under 10 mins usually. (Usually brought on by alcohol/stress/caffeine I find) permanent high frequency hearing loss from 2K+ hz (I have a family history of Vestibular migraine symptoms and high frequency hear loss from a young age) Other episodes were classic migraine aura and headache and sometimes aura but no headache and other times intense headache but no aura. Most days are slight dizziness/unsteady on feet and slight hissing in ears. So I'm planning on consulting a neurologist to try some migraine prevention medication in hope I can arrive at a solution

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