What you need to take away from this video, AKA, the Rule of 4's!: (1) Divide the CN's up by 4's. They correspond to the sections of the brainstem as you increase in number by 4. For example: CN 1-4 (Midbrain), CN5-8 (Pons), CN9-12 (Medulla). (2) Then, CN's that divide equally into 12 are MIDLINE and those who do NOT divided equally into 12 are LATERAL. For example: CN 3, 4, 6, and 12 are all MIDLINE. CN 5, 7, 9, 10, and 11 are all LATERAL (you omit the first 2 CNs). (3) Next, determine if the deficit is MOTOR or SENSORY. Motor deficits are midline and sensory deficits are lateral (sensory = side). IF YOU UNDERSTAND THESE RULES YOU WILL NEVER GET A BRAINSTEM STROKE QUESTION WRONG!!!! ***Example #3 was removed from the video**
DirtyUSMLE your chanel is amazinggg , omg ! I just came across of it and after each video everything seems so simple . thanks for doing it , you just an USMLE angel lol 😁😁😁😁😁
Great videos! Could you please pin your comment to the top of the list? A lot of people are commenting regarding the CN XI and XII mix-up in the video. Thanks.
Also, questions may ask which artery is blocked in the stroke so it's good to know which artery supplies which region of the brainstem. Midbrain = PCA Lateral Pons = AICA Medial pons = Basilar Lateral medulla = PICA Medial medulla = ASA
I think it's also important to remember that tongue deviations are ipsilateral, meaning they're on the same side of the lesion. Like if his tongue is deviated to the left, the lesion is probably on the left side and vice versa
As far as I know 4,7,10 th CN causes opposite site involvement rest has ipsilateral site involvement..... As touge is supplied by 12th nerve so ipsilateral involvement will take palce and uvela is supplied by 10th nerve so contralateral involvement wil take place.......plz correct me if um wrong....
The vignette should say 'he is unable to move his eyes to the RIGHT' as this is a RIGHT sided stroke and CN motor loss is IPSILATERAL (CN6 Abducens in this case - he can't abduct to the right).
intelligence is not whether you can understand hard topics, but rather if you can distill them and explain them in the simplest way. that is you, sir dirty. thank you!
I love you. I've read the Rule of 4's, I've watched the Boards and Beyond videos on the Rule of 4's, I've freaked out about the Rule of 4's, and it wasn't until I watched your video that I've been able to just take a deep breath and calm down. Thank you for explaining it so simply and giving examples on how we can apply it.
Been practicing (as non neuro doc) for years and I just understood stroke lesions now because of this video! Why did I just discover this? Thank you so much 🙏🏻😊
THIS IS BY FAR THE BEST VIDEO I HAVE SEEN ON THIS TOPIC.. I SPENT HOURS ON MY ANATOMY BOOK WITHOUT A FRACTION OF THE BENEFIT I GOT FROM THIS VIDEO.. THANKS A MILLION !!!!
9:00 The stroke is medial but you cannot 100% localize it to the pons. CN 3 and CN 6 connect via the MEDIAL LONGITUDINAL FASCICULUS and therefore damage to the MLF can be anywhere from the midbrain to the pons. The stroke might have not hit exclusively CN . But i would guess the pons as well. The second example with CN 12 vs 11 is incorrect however people have mentioned this already OVERALL AMAZINGLY GREAT JOB!
You explained the rules of stroke with easy words.Recently in Japan the examinations of medical license have lots of clinical situation questions. It seems to be natural, but in the past this exams was different from those recently. In the past there are a lot of questions with simple facts ,thus it was like a quiz... The age has been changing...
I also think it's important to remember the level of stroke, ie with cortical strokes we can say right or left stroke with more confidence than if stroke were to happen in internal capsule or other lower structures in the brain, nerve tracts pathways right!!!
Dirty, Coming on here post step and comlex to thank you for all these extra points. Between both exams I think I had a good 20-30questions related to this and I’m not joking. Bless you, your team, and everyone you love.
Internal carotid meets at base of skull branch into MCA & ACA (anterior communicating artery) Vertebral artery give rise basilar than to posterior cerebral (posterior communicating artery)
SIGNS OF STROKE::: left side neck arm pain, slurry speech, can't smile, face dropping to 1 side, difficult swallowing. REASONS FOR STROKE::: worrying too much, high blood pressure, high diebetes/ sugar levels. CURE/ PREVENTION- diet, exercise. Eat fruits to LOWER blood pressure. For inflammation eat raw root turmeric haldi. Tea bags r giving headaches so can't be trusted. And eating too much sugar and sweetners give dark circles , loss of hair, memory loss. herpes can be caught smoking the hookah pipe. Hepatitis can be cured by drinking 1 glass of coconut water per day.- plz avoid drinking anything straight out of fridge- not good for heart I'm telling you. Lipoma LUMPS gone by fasting for at least 16hrs because fasting eats up cysts n tumours, lipoma lumps, eating omega 3, raw turmeric, drinking more water, exercising, massaging body BEFORE breakfast dinner . Plz AVOID cakes , muffins, doughnuts, fizzy drinks fried foods, soy sauce as they cause LUMPS. GET MOVING- you will notice that tingling sensation on LUMPS after exercising- proof. Also same feeling after drinking fizzy drinks- notice plz LACK OF WATER , CIRCULATION also cause of LUMPS in body. I spent a fortune on homeopathic tablets but to be honest doc put turmeric in those tablets. Surgery never is the cure knew a lady with so many lupms she got so many operations. Never the cure. To prevent strokes eat Apple banana n pears. To lower blood pressure immediately plz eat banana. Fruits can LOWER blood pressure and by drinking more water throughout the day. - plz avoid drinking n eating while standing n walking it's bad for the heart and joints. I eat on the floor/ carpet/ rug. Fibroids can be prevented by Avoiding chicken liver, tomato seeds, white flour so doughnuts cakes white sugars. Plz note too much lack of FERRITIN and IRON in body may cause heart attack so get eating beetroot, spinach carrots plz- avoid for few hours coffee milk, cake, doughnuts, cream, tea ,wholemeal bread, pitta as these STOP iron absorption so not your best friend
Tongue deviation is controlled by cranial nerve 12. In this case the left CN 12 would’ve been affected! By the way , you’re doing an amazing job helping us out ! You’re help and time is highly appreciated!
Yes, there was an annotation in the video that addressed this error. I'm not sure if UA-cam just doesn't display the annotations anymore, or if you guys are overlooking the subtext. Either way, you are correct.
Thank you so much for the video,Helpful tips!.I just wanted to point out in The four motor midline syndromes.medial lemniscus isnt motor it is sensory tract
The best, smart teaching , i watch a lot of a topic to find wich video is best. but after comparing with others finally I find your videos as the best , if there is your video, there that will be the best out there
Thank you so very much. I am a 2 major things survivor and 3 subsiquent concussions that I know of. I would love to be a neurologist (I know the material) I just can't afford the school nor do I have the attention span to go to college anymore. I really appreciate having this information available both to understand myself and to follow my passion even if I can't make it a career.
SIGNS OF STROKE::: left side neck arm pain, slurry speech, can't smile, face dropping to 1 side, difficult swallowing. REASONS FOR STROKE::: worrying too much, high blood pressure, high diebetes/ sugar levels. CURE/ PREVENTION- diet, exercise. Eat fruits to LOWER blood pressure. For inflammation eat raw root turmeric haldi. Tea bags r giving headaches so can't be trusted. And eating too much sugar and sweetners give dark circles , loss of hair, memory loss. herpes can be caught smoking the hookah pipe. Hepatitis can be cured by drinking 1 glass of coconut water per day.- plz avoid drinking anything straight out of fridge- not good for heart I'm telling you. Lipoma LUMPS gone by fasting for at least 16hrs because fasting eats up cysts n tumours, lipoma lumps, eating omega 3, raw turmeric, drinking more water, exercising, massaging body BEFORE breakfast dinner . Plz AVOID cakes , muffins, doughnuts, fizzy drinks fried foods, soy sauce as they cause LUMPS. GET MOVING- you will notice that tingling sensation on LUMPS after exercising- proof. Also same feeling after drinking fizzy drinks- notice plz LACK OF WATER , CIRCULATION also cause of LUMPS in body. I spent a fortune on homeopathic tablets but to be honest doc put turmeric in those tablets. Surgery never is the cure knew a lady with so many lupms she got so many operations. Never the cure. To prevent strokes eat Apple banana n pears. To lower blood pressure immediately plz eat banana. Fruits can LOWER blood pressure and by drinking more water throughout the day. - plz avoid drinking n eating while standing n walking it's bad for the heart and joints. I eat on the floor/ carpet/ rug. Fibroids can be prevented by Avoiding chicken liver, tomato seeds, white flour so doughnuts cakes white sugars. Plz note too much lack of FERRITIN and IRON in body may cause heart attack so get eating beetroot, spinach carrots plz- avoid for few hours coffee milk, cake, doughnuts, cream, tea ,wholemeal bread, pitta as these STOP iron absorption so not your best friend
I am a stroke survivors and mine was caused by stress and eating too much junk food from take away stores like McKay and other fast food outlets in my area. I suffered a stroke at home and my dad got in contact with the local Ambulance service to take me to the new Royal Adelaide Hospital to get treated immediately with medication and surgery to insert a stent into my right side of my brain via my wrist instead of my groin and then transferred to the Flinders Rehabilitation Centre at Bedford Park for the next few months to recover properly and start my Rehab the next day. I had the use of their equipment like the super big treadmill and robotic arm to which was attached to a computer game. It was fun at that time but it was hard work and it made me tired and had no energy to go on further. I was in the Tubrok Ward for the same amount of time. The staff including the doctors,nurses and physiotherapy team who got me up and moving again. After many months in Rehab sessions and I am back at home doing okay and 🚶♂️ every day even when it is cold and windy. I will still go out for my walk. If I don't do this my joints will seize up and I will not go for my usual walk for an hour or so.
Language disorders are associated with MCA rather than PCA lesions and specifically left MCA (LEFT = LANGUAGE). Stem MCA initially presents as global aphasia (comprehension = NO, fluent = NO, repetition = NO, superior division MCA with Broca's aphasia (comprehension = YES, fluent = NO, repetition = NO), inferior MCA with Wernicke's aphasia (comprehension = NO, fluent = YES, repetition = NO). PCA lesions can affect the thalamus and produce contralateral hemianesthesia, or more rarely a disconnect syndrome alexia without agraphia (L PCA - right hemisphere can't read but can't pass visual info to L hemisphere, which can read). Very nice in general!!
🙂Muito obrigado pelo que fez pela minha mãe,dá gosto ver todos os seus vídeos doutor. Isso aí ! Até cortar os próprios defeitos pode ser perigoso. Nunca se sabe qual é o defeito que sustenta nosso edifício inteiro.
Hi, for Case #2, the options when you first showed us the question were all related to the midbrain. However, later on, the options were related to the pons. Were the options originally supposed to be related to the midbrain or the pons?
In case #2 before explanation option were midbrain which is i think typing mistake but you correct it after explanation 🙌🙌. Btw nice & crisp concise explanation , Thank you 🙏
The second question given for brainstem strokes has two different sets of answer choices. The first set are all midbrain and when the answers are revealed they all say pontine.
SIGNS OF STROKE::: left side neck arm pain, slurry speech, can't smile, face dropping to 1 side, difficult swallowing. REASONS FOR STROKE::: worrying too much, high blood pressure, high diebetes/ sugar levels. CURE/ PREVENTION- diet, exercise. Eat fruits to LOWER blood pressure. For inflammation eat raw root turmeric haldi. Tea bags r giving headaches so can't be trusted. And eating too much sugar and sweetners give dark circles , loss of hair, memory loss. herpes can be caught smoking the hookah pipe. Hepatitis can be cured by drinking 1 glass of coconut water per day.- plz avoid drinking anything straight out of fridge- not good for heart I'm telling you. Lipoma LUMPS gone by fasting for at least 16hrs because fasting eats up cysts n tumours, lipoma lumps, eating omega 3, raw turmeric, drinking more water, exercising, massaging body BEFORE breakfast dinner . Plz AVOID cakes , muffins, doughnuts, fizzy drinks fried foods, soy sauce as they cause LUMPS. GET MOVING- you will notice that tingling sensation on LUMPS after exercising- proof. Also same feeling after drinking fizzy drinks- notice plz LACK OF WATER , CIRCULATION also cause of LUMPS in body. I spent a fortune on homeopathic tablets but to be honest doc put turmeric in those tablets. Surgery never is the cure knew a lady with so many lupms she got so many operations. Never the cure. To prevent strokes eat Apple banana n pears. To lower blood pressure immediately plz eat banana. Fruits can LOWER blood pressure and by drinking more water throughout the day. - plz avoid drinking n eating while standing n walking it's bad for the heart and joints. I eat on the floor/ carpet/ rug. Fibroids can be prevented by Avoiding chicken liver, tomato seeds, white flour so doughnuts cakes white sugars. Plz note too much lack of FERRITIN and IRON in body may cause heart attack so get eating beetroot, spinach carrots plz- avoid for few hours coffee milk, cake, doughnuts, cream, tea ,wholemeal bread, pitta as these STOP iron absorption so not your best friend
in the last example why not the answer is A option (LEFT MEDIAL PONTINE STROKE) because it is written in the book lesion above brainstem will causes contralateral cranial nerve palsy and lesion at the level of brain stem causes ipsilateral cranial nerve palsy
First Aid says Language is an MCA issue. Aphasia occurs during an MCA stroke if patient strokes in dominant hemisphere, usually the left (Ref: FA, 2017 p. 484) PCA stroke does cause vision issues though (Re: FA, 2017 P. 485)
@@DirtyMedicine Is it not true though that speech is more associated with the MCA than the PCA like it says in the video? My understanding of where Broca's and Wernicke's area are would suggest an MCA infarct would be more likely to affect them also.
Great video & honest response re mistake! I wish in the UK MRCP they did the same they of putting the named syndrome in brackets. We can be asked Paranauds & need to remember it's X location rather than be able to show we can localise correctly!
Hey, great simplification but I still don't understand some things: if a patient presents with facial paralysis symptoms do I conclude that its CN 7 ➜ lateral Pons (first rule) or is it Midline because its a Motor syndrome of a CN nucleus? (second rule) ? also st 6:00 min you said Medial lemniscus (ie Proprioception and vibration), but that's not a motor syndrome but clearly a sensory deficit...? Hope someone can clear this up for me..?
Doubt regarding Case 2. If the CN VI nuclei is being involved, don't we get Ipsilateral palsy? So the movement of eyes towards right only should be impaired if it's a right sided involvement of pons, isn't it?
@@ProfessorSerperior "cross findings" is related to corticobulbar tract EXCEPT cranial nerve III, IV, VI, XII, so they are different from diffuse motor stroke, so this case would be left brain stem stroke with right medial pontine stroke
In Australia the Emergency number is triple zero and that would make contact with the local Ambulance service in your town city or state. Never use the 911 number because this is an American service and not an Australian service.
SIGNS OF STROKE::: left side neck arm pain, slurry speech, can't smile, face dropping to 1 side, difficult swallowing. REASONS FOR STROKE::: worrying too much, high blood pressure, high diebetes/ sugar levels. CURE/ PREVENTION- diet, exercise. Eat fruits to LOWER blood pressure. For inflammation eat raw root turmeric haldi. Tea bags r giving headaches so can't be trusted. And eating too much sugar and sweetners give dark circles , loss of hair, memory loss. herpes can be caught smoking the hookah pipe. Hepatitis can be cured by drinking 1 glass of coconut water per day.- plz avoid drinking anything straight out of fridge- not good for heart I'm telling you. Lipoma LUMPS gone by fasting for at least 16hrs because fasting eats up cysts n tumours, lipoma lumps, eating omega 3, raw turmeric, drinking more water, exercising, massaging body BEFORE breakfast dinner . Plz AVOID cakes , muffins, doughnuts, fizzy drinks fried foods, soy sauce as they cause LUMPS. GET MOVING- you will notice that tingling sensation on LUMPS after exercising- proof. Also same feeling after drinking fizzy drinks- notice plz LACK OF WATER , CIRCULATION also cause of LUMPS in body. I spent a fortune on homeopathic tablets but to be honest doc put turmeric in those tablets. Surgery never is the cure knew a lady with so many lupms she got so many operations. Never the cure. To prevent strokes eat Apple banana n pears. To lower blood pressure immediately plz eat banana. Fruits can LOWER blood pressure and by drinking more water throughout the day. - plz avoid drinking n eating while standing n walking it's bad for the heart and joints. I eat on the floor/ carpet/ rug. Fibroids can be prevented by Avoiding chicken liver, tomato seeds, white flour so doughnuts cakes white sugars. Plz note too much lack of FERRITIN and IRON in body may cause heart attack so get eating beetroot, spinach carrots plz- avoid for few hours coffee milk, cake, doughnuts, cream, tea ,wholemeal bread, pitta as these STOP iron absorption so not your best friend
@DirtyUSMLE Great video! Just a small question, in case 3 the tongue deviation is due to CN12, wouldn't that imply a MEDIAL stroke not a lateral one? Sorry if I am being stupid. Thanks
for the second case, aren't coritospinal, spinothalamic and DCML tracts contralateral, and CN defecitis ipsilateral in the brain stem? i.e they should not be able to move eye laterally to the right
What you need to take away from this video, AKA, the Rule of 4's!:
(1) Divide the CN's up by 4's. They correspond to the sections of the brainstem as you increase in number by 4.
For example: CN 1-4 (Midbrain), CN5-8 (Pons), CN9-12 (Medulla).
(2) Then, CN's that divide equally into 12 are MIDLINE and those who do NOT divided equally into 12 are LATERAL.
For example: CN 3, 4, 6, and 12 are all MIDLINE. CN 5, 7, 9, 10, and 11 are all LATERAL (you omit the first 2 CNs).
(3) Next, determine if the deficit is MOTOR or SENSORY. Motor deficits are midline and sensory deficits are lateral (sensory = side).
IF YOU UNDERSTAND THESE RULES YOU WILL NEVER GET A BRAINSTEM STROKE QUESTION WRONG!!!!
***Example #3 was removed from the video**
DirtyUSMLE your chanel is amazinggg , omg ! I just came across of it and after each video everything seems so simple . thanks for doing it , you just an USMLE angel lol 😁😁😁😁😁
PRESSURE VOLUME LOOPS ... There's no one else but you who can explain such tough concept of cardio... Please help us with that.
Thx for the videos! Would be nice if you could cover "headache" and/or "thyroid diseases” (not just hypo-/hyperthyroidism)
High-yield microbiology , please ))
Great videos! Could you please pin your comment to the top of the list? A lot of people are commenting regarding the CN XI and XII mix-up in the video.
Thanks.
The person who came up with The Rule of 4s deserves a Nobel Prize for helping out students worldwide
agree, Dr peter gates 2005
100% ....i always used to skip this topic before I knew the rule of 4!😅
I understood the Rules of Force! 😅
Mine is nerve inflammation the neuroligist said. How's that?
Also, questions may ask which artery is blocked in the stroke so it's good to know which artery supplies which region of the brainstem.
Midbrain = PCA
Lateral Pons = AICA
Medial pons = Basilar
Lateral medulla = PICA
Medial medulla = ASA
Thankuuu so much nicely and in a very easily explained way
thanks for sharing , so sweet
Thanku
Thanks
Lovely!
I think it's also important to remember that tongue deviations are ipsilateral, meaning they're on the same side of the lesion. Like if his tongue is deviated to the left, the lesion is probably on the left side and vice versa
Waleed Murad yup
“ Lick to the lesion”. This is how i usually remember this. always had hard time remembering that
Uvular deviation is opposite! I like that "Lick the lesion" mnemonic
T-ongue
T-owards the lesion
Uvul-A
A-way from the lesion
As far as I know 4,7,10 th CN causes opposite site involvement rest has ipsilateral site involvement..... As touge is supplied by 12th nerve so ipsilateral involvement will take palce and uvela is supplied by 10th nerve so contralateral involvement wil take place.......plz correct me if um wrong....
Spent an entire semester in neuro class and you broke it down better than either of my professors could. Thank you!
The vignette should say 'he is unable to move his eyes to the RIGHT' as this is a RIGHT sided stroke and CN motor loss is IPSILATERAL (CN6 Abducens in this case - he can't abduct to the right).
Yep that’s right, I noticed that too. Thank you for reassurance
Yes, but we should always be aware about 4th nerve which decussates to the opposite side.
intelligence is not whether you can understand hard topics, but rather if you can distill them and explain them in the simplest way. that is you, sir dirty. thank you!
I love you. I've read the Rule of 4's, I've watched the Boards and Beyond videos on the Rule of 4's, I've freaked out about the Rule of 4's, and it wasn't until I watched your video that I've been able to just take a deep breath and calm down. Thank you for explaining it so simply and giving examples on how we can apply it.
Been practicing (as non neuro doc) for years and I just understood stroke lesions now because of this video! Why did I just discover this? Thank you so much 🙏🏻😊
Absolutely brilliant. This cleared it up 1000%. Thank you.
THIS IS BY FAR THE BEST VIDEO I HAVE SEEN ON THIS TOPIC.. I SPENT HOURS ON MY ANATOMY BOOK WITHOUT A FRACTION OF THE BENEFIT I GOT FROM THIS VIDEO..
THANKS A MILLION !!!!
maaaan....God bless you brother...thank you for spreading the knowledge.
Made me want to cry; I've struggled with answering cva qs for so long.
9:00
The stroke is medial but you cannot 100% localize it to the pons. CN 3 and CN 6 connect via the MEDIAL LONGITUDINAL FASCICULUS
and therefore damage to the MLF can be anywhere from the midbrain to the pons. The stroke might have not hit exclusively CN . But i would guess the pons as well.
The second example with CN 12 vs 11 is incorrect however people have mentioned this already
OVERALL AMAZINGLY GREAT JOB!
You explained the rules of stroke with easy words.Recently in Japan the examinations of medical license have lots of clinical situation questions. It seems to be natural, but in the past this exams was different from those recently. In the past there are a lot of questions with simple facts ,thus it was like a quiz... The age has been changing...
Thank you so much !! This is of great help, 5 years of medical school but this single video made it so simple. God bless you !!
I also think it's important to remember the level of stroke, ie with cortical strokes we can say right or left stroke with more confidence than if stroke were to happen in internal capsule or other lower structures in the brain, nerve tracts pathways right!!!
One of the best videos I’ve ever watched on stroke,,, just woww
Dude you’re a life saver, thank you so much
CN 12 is responsible for tongue movement. CN 11 is accessory - head, neck and shoulder movement.
thank u so so so much I am literally unable to describe how helpful that was.
Its 3:30 am and this video shows up on the top as i open youtube, and i now feel like crying cause you've made my entire neurology easy! 🥺 Thankyouu
I literally breathed a sigh of relief when I saw that you had a video on this...
Dirty,
Coming on here post step and comlex to thank you for all these extra points. Between both exams I think I had a good 20-30questions related to this and I’m not joking.
Bless you, your team, and everyone you love.
OMG thank you, studying for step 3 and I am reviewing the basics
A big salute to this person who made this I was so dam worried and was hiding always from these topic .thanks to this
Thank you, man. You don't know how much it helps me. I am not good with basic neurology. And this helps me tremendously.
You are extremely talented. The way you simplified this was amazing. Thank you
Internal carotid meets at base of skull branch into MCA & ACA (anterior communicating artery)
Vertebral artery give rise basilar than to posterior cerebral (posterior communicating artery)
hey man, thanks alot , i was all the time freaking out whenever i see stroke question now i feel much more confident ,,,,
SIGNS OF STROKE::: left side neck arm pain, slurry speech, can't smile, face dropping to 1 side, difficult swallowing.
REASONS FOR STROKE::: worrying too much, high blood pressure, high diebetes/ sugar levels.
CURE/ PREVENTION- diet, exercise. Eat fruits to LOWER blood pressure.
For inflammation eat raw root turmeric haldi.
Tea bags r giving headaches so can't be trusted. And eating too much sugar and sweetners give dark circles , loss of hair, memory loss.
herpes can be caught smoking the hookah pipe.
Hepatitis can be cured by drinking 1 glass of coconut water per day.- plz avoid drinking anything straight out of fridge- not good for heart I'm telling you.
Lipoma LUMPS gone by fasting for at least 16hrs because fasting eats up cysts n tumours, lipoma lumps, eating omega 3, raw turmeric, drinking more water, exercising, massaging body BEFORE breakfast dinner . Plz AVOID cakes , muffins, doughnuts, fizzy drinks fried foods, soy sauce as they cause LUMPS. GET MOVING- you will notice that tingling sensation on LUMPS after exercising- proof. Also same feeling after drinking fizzy drinks- notice plz
LACK OF WATER , CIRCULATION also cause of LUMPS in body. I spent a fortune on homeopathic tablets but to be honest doc put turmeric in those tablets. Surgery never is the cure knew a lady with so many lupms she got so many operations. Never the cure.
To prevent strokes eat Apple banana n pears.
To lower blood pressure immediately plz eat banana. Fruits can LOWER blood pressure and by drinking more water throughout the day. - plz avoid drinking n eating while standing n walking it's bad for the heart and joints. I eat on the floor/ carpet/ rug.
Fibroids can be prevented by Avoiding chicken liver, tomato seeds, white flour so doughnuts cakes white sugars. Plz note too much lack of FERRITIN and IRON in body may cause heart attack so get eating beetroot, spinach carrots plz- avoid for few hours coffee milk, cake, doughnuts, cream, tea ,wholemeal bread, pitta as these STOP iron absorption so not your best friend
WHAT A GENIUS.
Wow this was hands down one of the best videos I've watched. Great visual aids and you explained it so simply. THANK YOU SO MUCH!!!
@6:58 the Questions don't have Pons as the choices given, me knowing that LR6 was an issue. but at @8:23 the choices were corrected
Idk how many lives has he saved! Thank you!
You are a god Dirty! A literal god for making this video!
best stoke localisation video i have seen so far. thankyou
Tongue deviation is controlled by cranial nerve 12. In this case the left CN 12 would’ve been affected!
By the way , you’re doing an amazing job helping us out ! You’re help and time is highly appreciated!
Yes, there was an annotation in the video that addressed this error. I'm not sure if UA-cam just doesn't display the annotations anymore, or if you guys are overlooking the subtext. Either way, you are correct.
The best video on brainstem lesions so far, tysm!
You make great videos too 😃
@@gogoblyn Wow Amrinder, thank you so much!
Thank you so much for the video,Helpful tips!.I just wanted to point out in
The four motor midline syndromes.medial lemniscus isnt motor it is sensory tract
Thanks for the video..10.59 it shoud be CN 12 ( 11 is supply to shoulder muscles not to tongue )
i am thinking the same, doesnt fit here.
The best, smart teaching , i watch a lot of a topic to find wich video is best. but after comparing with others finally I find your videos as the best , if there is your video, there that will be the best out there
Thank you so much, this is the first time i understand stroke syndromes.
If i could inform medical students and/or physicians of only one medical video out there, this would be it!!
Just the organization of the nerves has helped so much!!!!! why can't everyone teach this!! Thank you so much!
Thank you so very much. I am a 2 major things survivor and 3 subsiquent concussions that I know of. I would love to be a neurologist (I know the material) I just can't afford the school nor do I have the attention span to go to college anymore.
I really appreciate having this information available both to understand myself and to follow my passion even if I can't make it a career.
SIGNS OF STROKE::: left side neck arm pain, slurry speech, can't smile, face dropping to 1 side, difficult swallowing.
REASONS FOR STROKE::: worrying too much, high blood pressure, high diebetes/ sugar levels.
CURE/ PREVENTION- diet, exercise. Eat fruits to LOWER blood pressure.
For inflammation eat raw root turmeric haldi.
Tea bags r giving headaches so can't be trusted. And eating too much sugar and sweetners give dark circles , loss of hair, memory loss.
herpes can be caught smoking the hookah pipe.
Hepatitis can be cured by drinking 1 glass of coconut water per day.- plz avoid drinking anything straight out of fridge- not good for heart I'm telling you.
Lipoma LUMPS gone by fasting for at least 16hrs because fasting eats up cysts n tumours, lipoma lumps, eating omega 3, raw turmeric, drinking more water, exercising, massaging body BEFORE breakfast dinner . Plz AVOID cakes , muffins, doughnuts, fizzy drinks fried foods, soy sauce as they cause LUMPS. GET MOVING- you will notice that tingling sensation on LUMPS after exercising- proof. Also same feeling after drinking fizzy drinks- notice plz
LACK OF WATER , CIRCULATION also cause of LUMPS in body. I spent a fortune on homeopathic tablets but to be honest doc put turmeric in those tablets. Surgery never is the cure knew a lady with so many lupms she got so many operations. Never the cure.
To prevent strokes eat Apple banana n pears.
To lower blood pressure immediately plz eat banana. Fruits can LOWER blood pressure and by drinking more water throughout the day. - plz avoid drinking n eating while standing n walking it's bad for the heart and joints. I eat on the floor/ carpet/ rug.
Fibroids can be prevented by Avoiding chicken liver, tomato seeds, white flour so doughnuts cakes white sugars. Plz note too much lack of FERRITIN and IRON in body may cause heart attack so get eating beetroot, spinach carrots plz- avoid for few hours coffee milk, cake, doughnuts, cream, tea ,wholemeal bread, pitta as these STOP iron absorption so not your best friend
Amazing video! This was so helpful when I took my SCRN (Stroke Certification) exam.
WOW, Straight THANK YOU
Omg thankyou so much! You are a saviour
What a genius 👏🏻
Thanks you Dirty, greetings from Habana, Cuba. I hope you continues making videos like this👍
I am a stroke survivors and mine was caused by stress and eating too much junk food from take away stores like McKay and other fast food outlets in my area. I suffered a stroke at home and my dad got in contact with the local Ambulance service to take me to the new Royal Adelaide Hospital to get treated immediately with medication and surgery to insert a stent into my right side of my brain via my wrist instead of my groin and then transferred to the Flinders Rehabilitation Centre at Bedford Park for the next few months to recover properly and start my Rehab the next day. I had the use of their equipment like the super big treadmill and robotic arm to which was attached to a computer game. It was fun at that time but it was hard work and it made me tired and had no energy to go on further. I was in the Tubrok Ward for the same amount of time. The staff including the doctors,nurses and physiotherapy team who got me up and moving again. After many months in Rehab sessions and I am back at home doing okay and 🚶♂️ every day even when it is cold and windy. I will still go out for my walk. If I don't do this my joints will seize up and I will not go for my usual walk for an hour or so.
thank you for sharing your story. i hope you are doing better!
Brilliant! I have been an Internist for over 30 years. NO ONE ever explained this in this way. Thank you so much !!!!!!
Video was awesome I tried to solve 2nd ques but i thought answer should be out of options & it was (Check 6:47 & 8:23)
Thank you so much, this video is amazing, quick easy, organized and to the point, I LOVE it.
True blue
Language disorders are associated with MCA rather than PCA lesions and specifically left MCA (LEFT = LANGUAGE). Stem MCA initially presents as global aphasia (comprehension = NO, fluent = NO, repetition = NO, superior division MCA with Broca's aphasia (comprehension = YES, fluent = NO, repetition = NO), inferior MCA with Wernicke's aphasia (comprehension = NO, fluent = YES, repetition = NO). PCA lesions can affect the thalamus and produce contralateral hemianesthesia, or more rarely a disconnect syndrome alexia without agraphia (L PCA - right hemisphere can't read but can't pass visual info to L hemisphere, which can read).
Very nice in general!!
I am truly thrilled! Ur teaching is a blessing!! Thank you!
Really helpful!!! Hands down Best video on strokes. Thankyou
🙂Muito obrigado pelo que fez pela minha mãe,dá gosto ver todos os seus vídeos doutor. Isso aí ! Até cortar os próprios defeitos pode ser perigoso. Nunca se sabe qual é o defeito que sustenta nosso edifício inteiro.
Hi, for Case #2, the options when you first showed us the question were all related to the midbrain. However, later on, the options were related to the pons. Were the options originally supposed to be related to the midbrain or the pons?
In case #2 before explanation option were midbrain which is i think typing mistake but you correct it after explanation 🙌🙌. Btw nice & crisp concise explanation , Thank you 🙏
Options changed from Midbrain to pontine in the end. Though pontine was the correct answer anyway. Video was great by the way!
The second question given for brainstem strokes has two different sets of answer choices. The first set are all midbrain and when the answers are revealed they all say pontine.
Yes, I was confused about that too
Thank you sooo much!! The illustration was very informative and the questions were a very helpful application
What a channel what a video 😍
You are amazing dear
maan this video is so useful. after struggling many years with stroke syndromes, it's a peace of cake now
SIGNS OF STROKE::: left side neck arm pain, slurry speech, can't smile, face dropping to 1 side, difficult swallowing.
REASONS FOR STROKE::: worrying too much, high blood pressure, high diebetes/ sugar levels.
CURE/ PREVENTION- diet, exercise. Eat fruits to LOWER blood pressure.
For inflammation eat raw root turmeric haldi.
Tea bags r giving headaches so can't be trusted. And eating too much sugar and sweetners give dark circles , loss of hair, memory loss.
herpes can be caught smoking the hookah pipe.
Hepatitis can be cured by drinking 1 glass of coconut water per day.- plz avoid drinking anything straight out of fridge- not good for heart I'm telling you.
Lipoma LUMPS gone by fasting for at least 16hrs because fasting eats up cysts n tumours, lipoma lumps, eating omega 3, raw turmeric, drinking more water, exercising, massaging body BEFORE breakfast dinner . Plz AVOID cakes , muffins, doughnuts, fizzy drinks fried foods, soy sauce as they cause LUMPS. GET MOVING- you will notice that tingling sensation on LUMPS after exercising- proof. Also same feeling after drinking fizzy drinks- notice plz
LACK OF WATER , CIRCULATION also cause of LUMPS in body. I spent a fortune on homeopathic tablets but to be honest doc put turmeric in those tablets. Surgery never is the cure knew a lady with so many lupms she got so many operations. Never the cure.
To prevent strokes eat Apple banana n pears.
To lower blood pressure immediately plz eat banana. Fruits can LOWER blood pressure and by drinking more water throughout the day. - plz avoid drinking n eating while standing n walking it's bad for the heart and joints. I eat on the floor/ carpet/ rug.
Fibroids can be prevented by Avoiding chicken liver, tomato seeds, white flour so doughnuts cakes white sugars. Plz note too much lack of FERRITIN and IRON in body may cause heart attack so get eating beetroot, spinach carrots plz- avoid for few hours coffee milk, cake, doughnuts, cream, tea ,wholemeal bread, pitta as these STOP iron absorption so not your best friend
in the last example why not the answer is A option (LEFT MEDIAL PONTINE STROKE)
because it is written in the book lesion above brainstem will causes contralateral cranial nerve palsy and lesion at the level of brain stem causes ipsilateral cranial nerve palsy
Nice presentation,well simplified approach,thanks a lot sir
Thank you so much ,GOD bless you with more wealth , Health and knowledge
Thanks for spreading the knowledge! 👍
First Aid says Language is an MCA issue. Aphasia occurs during an MCA stroke if patient strokes in dominant hemisphere, usually the left (Ref: FA, 2017 p. 484) PCA stroke does cause vision issues though (Re: FA, 2017 P. 485)
if the patient is right handed (and therefore the left hemisphere is dominant) then a Left MCA stroke can cause aphasia.
@@DirtyMedicine Is it not true though that speech is more associated with the MCA than the PCA like it says in the video? My understanding of where Broca's and Wernicke's area are would suggest an MCA infarct would be more likely to affect them also.
thanks dude u r a life saver
Fantastic!!!!!!!!!!! No words!! Thank youuuuu🙏🙏🙏🙏
Great video & honest response re mistake! I wish in the UK MRCP they did the same they of putting the named syndrome in brackets. We can be asked Paranauds & need to remember it's X location rather than be able to show we can localise correctly!
This was fantastic!!! What a great explanation! Thank you so much
amazingly done and beautifully created
AWESOME, JUST AMAZING.. THANKS 🙏🏾 SO MUCH!!!!
So helpfull and soo simple approach to learn about stroke cases salute u sir thanks so much ❤
By the best. Simple and easy to understand..Thank you
Woww. Excellent video. Thanks. You just made a difficult concept as easy as ABC. Thanks a lot.
Thanks for this video. Helped me a lot more than BnB did for this topic.
ang talino! ang galing! salamat sa tulong mo!!!
Hey, great simplification but I still don't understand some things:
if a patient presents with facial paralysis symptoms do I conclude that its CN 7 ➜ lateral Pons (first rule) or is it Midline because its a Motor syndrome of a CN nucleus? (second rule) ?
also st 6:00 min you said Medial lemniscus (ie Proprioception and vibration), but that's not a motor syndrome but clearly a sensory deficit...?
Hope someone can clear this up for me..?
Excellent video, so clear! thank you!
Thanks!!! Now everything is easier
Doubt regarding Case 2. If the CN VI nuclei is being involved, don't we get Ipsilateral palsy? So the movement of eyes towards right only should be impaired if it's a right sided involvement of pons, isn't it?
Correct: It's ipsilateral if it involves the nucleus or cranial nerves.
@@aarnoman1088 yes u r right :)
Yea "cross findings" is a classic sign of brainstem stroke. AKA left motor symptoms with right cranial nerve deficits
@@ProfessorSerperior "cross findings" is related to corticobulbar tract EXCEPT cranial nerve III, IV, VI, XII, so they are different from diffuse motor stroke, so this case would be left brain stem stroke with right medial pontine stroke
I am impressed with ur presentation
.Thank u so much, I understand this for the first time. How it was very was to know it perfectly .
Very simple strategy! Thank you.
In Australia the Emergency number is triple zero and that would make contact with the local Ambulance service in your town city or state. Never use the 911 number because this is an American service and not an Australian service.
man, god bless you !!!!!!!!!!!!!!
I respectfully request that you post a video with some more case study questions. PLEASE!!!!!!!
This is absolutely good !!
Thank you. I never understood stroke like this before.
SIGNS OF STROKE::: left side neck arm pain, slurry speech, can't smile, face dropping to 1 side, difficult swallowing.
REASONS FOR STROKE::: worrying too much, high blood pressure, high diebetes/ sugar levels.
CURE/ PREVENTION- diet, exercise. Eat fruits to LOWER blood pressure.
For inflammation eat raw root turmeric haldi.
Tea bags r giving headaches so can't be trusted. And eating too much sugar and sweetners give dark circles , loss of hair, memory loss.
herpes can be caught smoking the hookah pipe.
Hepatitis can be cured by drinking 1 glass of coconut water per day.- plz avoid drinking anything straight out of fridge- not good for heart I'm telling you.
Lipoma LUMPS gone by fasting for at least 16hrs because fasting eats up cysts n tumours, lipoma lumps, eating omega 3, raw turmeric, drinking more water, exercising, massaging body BEFORE breakfast dinner . Plz AVOID cakes , muffins, doughnuts, fizzy drinks fried foods, soy sauce as they cause LUMPS. GET MOVING- you will notice that tingling sensation on LUMPS after exercising- proof. Also same feeling after drinking fizzy drinks- notice plz
LACK OF WATER , CIRCULATION also cause of LUMPS in body. I spent a fortune on homeopathic tablets but to be honest doc put turmeric in those tablets. Surgery never is the cure knew a lady with so many lupms she got so many operations. Never the cure.
To prevent strokes eat Apple banana n pears.
To lower blood pressure immediately plz eat banana. Fruits can LOWER blood pressure and by drinking more water throughout the day. - plz avoid drinking n eating while standing n walking it's bad for the heart and joints. I eat on the floor/ carpet/ rug.
Fibroids can be prevented by Avoiding chicken liver, tomato seeds, white flour so doughnuts cakes white sugars. Plz note too much lack of FERRITIN and IRON in body may cause heart attack so get eating beetroot, spinach carrots plz- avoid for few hours coffee milk, cake, doughnuts, cream, tea ,wholemeal bread, pitta as these STOP iron absorption so not your best friend
@DirtyUSMLE Great video! Just a small question, in case 3 the tongue deviation is due to CN12, wouldn't that imply a MEDIAL stroke not a lateral one? Sorry if I am being stupid. Thanks
I think you are right. The video is wrong...CN 12 implies medial medullary stroke. Dont trust 100% what this video is saying.
made it like a breeze. Thanks u are awesome
Wernicke's / Broca's area supplied by MCA, so MCA stroke causes language issues (says PCA in this vid)
Source: uworld
for the second case, aren't coritospinal, spinothalamic and DCML tracts contralateral, and CN defecitis ipsilateral in the brain stem? i.e they should not be able to move eye laterally to the right
Same doubt, lateral rectus of the right side should be paralysed and left sided corticospinal tract. Please clarify.
Correct.
i had same problem. Answer should be left medial pontine. Generally it a great presentation
I thought so too!
Yes it should be ipsilateral gaze palsy. Cant look towards lesion in medial pontine stroke.
THANK YOU SO MUCH FOR THIS.
Love the video but the Medial Lemniscus is sensory and is placed in the motor syndromes. Small exception to the rule of 4 Ms that wasnt mentioned.
Love it . Saved my shelf exam
Best explanation ever!!