Approach to Acute Dizziness
Вставка
- Опубліковано 15 тра 2024
- 00:00 - Intro
01:04 - Case presentation
02:17 - Anatomy of the vestibular system
08:07 - H.I.N.T.S. examination
16:26 - Pathological differential diagnosis
39:56 - Back to the case...
40:44 - Diagnostic testing
42:58 - Treatments
45:13 - Management algorithm
Narrated by:
Igor Rybinnik, MD
Produced by:
Igor Rybinnik MD
Neurology Clerkship Director
Rutgers Robert Wood Johnson Medical School
Special thanks to Dr. Peter Johns, University of Ottawa for his invaluable input and corrections.
Patient videos courtesy of:
- Dr. Peter Johns, University of Ottawa ( / peterjohns84 )
- Newman-Toker DE, et al. H.I.N.T.S. to Diagnose Stroke in the Acute Vestibular Syndrome-Three-Step Bedside Oculomotor Exam More Sensitive than Early MRI DWI. Stroke. 2009 Nov; 40(11): 3504-3510.
Brain imaging cases courtesy of:
- A.Prof Frank Gaillard, Radiopaedia.org, rID: 10814
- Sand IK. Continuum 2016;22(3):864-896.
- Lee SU, et al. Cerebellum. 2019 Mar 2
Graphics, video clips adapted from:
- Cerebellum. Greg Dunn Design
- Netter FH. The Netter Collection of Medical Illustrations. 2nd ed. Saunders, 2013.
- Kandel ER, et al. Principles of Neural Science 5th Edition. McGraw Hill, 2012.
- Martin JH. Neuroanatomy Text and Atlas, 4th ed. McGraw Hill, 2012.
- Young Frankenstein. Dir Mel Books, Gruskoff/Venture Films, 1974.
- The Walk. Dri Robert Zemeckis, Sony Pictures Entertainment, 2015.
Disclaimer: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions expressed in this talk do not necessarily reflect those of Rutgers Robert Wood Johnson Medical school or Rutgers University as a whole.
It's amazing how you turn such a heavy branch that easy . My appreciation
Thank you very much, I struggle with patients with dizziness, I now can see the light, and hopefully turn water into wine some day.
You are the best! Thank you for your approach
A very comprehensive, informative and useful lecture indeed.
This is just fantastic! I just hit gold!
Excellent presentation. Thank you so much.
OMG this is the best video about Dizziness i ever see, thanks
THANK YOU SO MUCH!! What an amazing video and explanation! Thank you!!! ❤
This is such a THOROUGH COMPRESIVE PERTINENT explanation/educational video about "DIZZINESS"! Thank you so much making this video! It is soooooo helpful! Please make more of these types of video! Thank you so much again!
This is absolutely superb. Thank you so much for putting all this together!!
Awesome, I have been struggling with the HINTS exam for 1 year, which I finally understood in 10 mins lecture and whole dizziness in one video. thank you so much for excellent quality videos and material
It's awesome. Wonderful lecture. Thanks !
Excellent lectures. Great teacher.
Excellent presentation. Thank you very much...
THANKS a lot, really helpful! look forward to "recurrent, chronic vertigo" !
Master class in presentation. Outstanding! Highly recommend.
Thank you!
Brilliant!
Can’t get better than this!!!✌️
Thank you for the kind words!
Perfect!
100 thumbs up! Great presentation!
Very good explanation ❤
great pedagogic value, thanks!
Thank you. Comments and feedback is greatly appreciated.
Nice presentation. please make more videos.
This is really superb. I've seen many neurology educational videos and this is among the best. Very professionally done, entertaining and thorough. Great job!! I'm looking forward to watching the rest...
Thank you for the kind comments.
Very useful for practice and Post graduates
You never disappoint me
Superb video, kindly make other schemes for neurology complaints as well.
Superb video keep it up !!!!!
Thank you sir
Your videos are amazing. I will ask my students to watch your videos before class. Thank you so much
Thank you.
Phenomenal presentation. Delivery and visuals always keeps me focused and entertained! I look forward to utilizing these concepts in my upcoming neuro residency!
Thank you. Good luck.
I cannot say how gratefull I am to you. I am a neurology resident and it was so difficult to me :(, until I found your videos.!!
You are a awesome teacher!!!, explain easy and funny all the topics!,
THANK YOU VERY MUCH,!!!! 😀😀😄😄
I'm from Mexico by the way jeje
You are so welcome!
Great sir
You are great doctor.thanks alot from saudia arabia
Thanks a lot, i 'm a med student in greece aspiring to become a neurologist, this content is highly appreciated
I'm glad.
thanks
Mi inglés no es muy bueno, por eso escribo en español, pero muchas gracias por su video, entendí muy bien todos los conceptos, explica todo de una manera fácil y que permite evaluar al paciente de manera más apropiada. De nuevo, muchas gracias por este aporte y sus otros videos, que ham sido una maravilla pars mí.
Omg.. Loved this lecture. Thanks a lot
This is the first 50 minute lecture I stayed awake without caffeine! hehehe
No small feat!
17:50 you feet lightheaded 😂😂
Amazing explanation...best approach difficult to forget in practice..THANK YOU SIR
You're right! After a head trauma I had a onset of severe 24/7 Vertigo with nausea A MRI showed unilateral subtle middle cerebellar peduncle. Sadly it was not attributed to the head trauma.
I'm sorry to hear that. I hope you feel better.
@@theneurophile Thank you.
Please make videos on all neurosurgery topics
This is a very hard subject even for experienced neurologists.
Love this content, my only complaint is that we have to wait ~3-6 months between videos and my hunger for knowledge is great. I am a first year med student and would also love to connect if that is okay with you. I am an aspiring Pediatric Neurologist/Neurosurgeon.
Sorry. The day job is getting in the way :)
great video. question: during head impulse test patient tries to focus on the target (examiner's nose). So it is intentional. Why cortex is not involved?
Would you mind clarifying your question? The visual fixation is intentional and the frontal eye fields play a role in that. But the head impulse still reveals imbalance between two sides of the vestibular system in patients with vestibular neuritis. Cortical lesions will present with a stable deficit rather than a deficit that is only discoverable by head impulse.
Hello again. You mention an immune/autoimmune modulated disorder talk. Is that embedded in another talk?
Thank you!!
I still have to work on that talk. It's not ready yet.
Can I get pdf of summary flowchart
Hello, is it possible to use some of your pictures, from your excellent videos, for classes with students, neurology residents?
Of course! Just credit me when you display them.
I’ve been feeling dizzy every single day since the beginning of October I feel like I’m going to pass out and havent been able to work for 3 weeks after going to the ER. It has progressed to nighttime as well even when sleeping. All the test came back fine. Last night I became extremely dizzy and woke up at 2am and was extremely close to passing out laying in bed. I then experienced a panic attack which I believe helped me from actually fully passing out. Any opinions ?
I am sorry to hear about your troubles. Unfortunately, it is impossible to diagnose and treat people without a full proper evaluation and review of imaging and medical records. I highly suggest that you visit a neurologist. Feel better.
I have these symptoms, No Dr has done any of these test. I had craniotomy, cranial flap, peek implant. Do to depressed skull fracture. had vestibule physical therapy still had unsteadiness after standing after working kneeling eyes would not focus sometime i feel like I'm passing out Please Help
I’m sorry to hear that. You may certainly make an appointment with a Neurologist at Rutgers RWJMS and we will try to help. I hope you feel better.
I have one Question. There is a patient who have dizziness. I did physical exam including HIT, SKEW test, The result is HIT is positive but SKEW test is negative, What does it mean? Thanks
HIT positive/Skew negative is usually due to peripheral vestibulopathy (like vestibular neuritis).
@@theneurophile I am very appreciated to you. Thanks a lot.
at 27:07 ..internuclear opthal , not intranuc..?
Yes, you are correct. I will fix it in the next video. Thank you for catching that.
Hello, can you tell how do approach a patient who presents with acute dizzines, but every examination is negative - he doesnt have objective neurological findings, negative CT and CTA also normal blood test, normal arterial pressure, normal ECG… He is just dizzy and has nausea or vomited once…can you tell that patient has vestibular syndrome? How would you classife it. Thank you!
If the exam is completely normal and the patient is dizzy, you are likely dealing with a migraine.
@@theneurophile u would assume migraine even if a patient doesnt have history of headaches? Thank you for your answers! Really love your work.
@@pavolskacik5064 Thank you. I generally try avoiding assumptions. I would have a differential and systematically eliminate the most dangerous etiologies in my mind first. Organic lesions (peripheral or central) tend to present with deficits that are clearly visible. Migraine is a functional disorder that activates trigemino-cervical complex (and affects the nearby vestibular system) but not to the extent that an organic lesion does. So that ends up being a common cause of episodic vertigo without evidence of neurological findings.
Hi im 34 years old and i have a 1.8 cm colloid cyst in my brain and a vp shunt for hydrocephalus. Recently a suffered a severe episodes of vertigo. My neurosurgeon Said vertigo is not related to the cyst, but i M not So sure about it. Is posibile the cyst cause this vertigo? Thank you in advance 🥺
I am sorry to hear about your troubles. I am reluctant to offer any opinions based on the limited information provided. Unfortunately, it is impossible to diagnose and treat people without a full proper evaluation and review of imaging and medical records. I highly suggest that you visit a neurologist. I hope you feel better.
Thank you sir❤
Since it is So rare i would be so happy if you make a video about colloid cysts
I had a question I been feeling dizzy and pain nerves and sometimes I feel lightheaded and difficulties concentrating It happens out of no where I been to the ER numerous times and they haven't found anything I had a ct scan and Also had an MRI recently done and they found nothing any ideas ????it's horrible living this way not knowing 🙏
I am sorry that you are having difficulties. Unfortunately it is impossible to diagnose a person without being able to obtain full history, neurological examination and review all the imaging. I suggest you start by visiting a neurologist for a proper evaluation.
@@theneurophile thanks I seen a neurologist and she didn't see any findings on the mri but thank you for you're response 🙏🙏
@@chriscruz8269 If your neurologist didn't seen anything concerning, at least that is somewhat reassuring.
@@theneurophile yes for sure with your experience being a doctor anything else that can make someone feel so awful
@@chriscruz8269 Unfortunately the list of disorders that can cause dizziness is very very long.
So, dizziness is humorous. Good luck.
I dont get it!! How on earth did u make neurology so entertaining?!
Thank you! Trying hard.
Wait wait. He went to the er and the believed him when he said he is dizzy? I dont believe this story at all