You're really a great teacher. I've always been really confused on how to do the Dix Hall Pike and Epley and how to tell the difference between BPPV and Vestibular Neuritis/Cerebellar Stroke. I've learned so much and don't get a panic attack when someone shows up with dizziness as the chief complaint in primary care.
Wonderful explanation.I am here after reviewing Vertigo and see that I have been interpreting my Hallpike test incorrectly for years. I think the rotational component of the nystagmus is to blame for the common error of thinking horizontal nystagmus is the more common response to a dix hallpike. I frequently have my patients focus on a point on a wall after they lie down and I seem to point to a spot that has them gazing somewhat downward. This has probably accentuated the rotational nystagmus as you describe and has caused my confusion. Thank you for producing such great content.
I just discovered your channel and was humbled by my lack of knowledge on nystagmus. Thank you! I wonder what makes you Ottowanians so prolific on your rules and physical exam teachings. An earnest desire to save time and money and get the right diagnosis despite not making somebody broke I presume! From Denison TX - Home of the $9000 CT scan done several times daily.
Ian Stiell, Jeff Perry, Christian Vaillancourt, Venkatesh Thiruganasambandamoorthy, Jason Frank and many more who I count as friends and colleagues have helped inspire me to make my videos to help people learn vertigo. So much so, that at the age of 63, I will soon be an associate professor, something I though I would never attain.
Thank you for this hilariously accurate video! We see this quite a bit and hope that better educational tools and training can finally get the basics of the vestibular system known to all diagnosticians. Keep up the awesome work and let us know if we can help in any way!
That is why it doesn matter which maneuver you perform, whether is dix hallpike, head role test or Semont! What matters is the direction of nystagmus it produces!
Great video. Truly grateful for the work you've done in this field. Had a patient that had a few episodes of vertigo (all triggered after bending over or turning in bed) that lasted under a minute. Dix-Hallpike was negative and vertigo has not returned but continued to have residual but improving dizziness for a week or so (especially in morning). No nystagmus with fixation but upon exam, when asked to follow finger, 1-2 beats away from the direction of finger; regardless if gazing left or right, solely based on direction of pursuit (in this case beats in opposite direction of pursuit; beats right if pursuit towards left and visa versa). Any immediate thoughts? Catch up saccades?
@@PeterJohns I understand thank you. It's almost as though they are tracking beyond my finger and then correcting back to the finger. If anything pops in your head...
@@PeterJohns AAFP Volume 95 Number 3 February 1, 2017- it says if Dix Halpike is negative for nystagmus, consider orthostatic hypotension. Is that right?
@@remedamasco1343 Well, yes. But those patients will generally describe dizziness when going from lying or sitting to standing and not from turning over in bed or lying down in bed. And their blood pressure should drop if you take it lying and standing. If a patient has the typical history of BPPV, (no central features) and says it's when they rollover or lye down in bed, and yet their Dix-Hallpike test is negative, I'd do a supine roll test. ua-cam.com/video/VRjRTnIw9YE/v-deo.html If that was also not producing the typical nystagmus of HC BPPV. then I would repeat the Dix-Hallpike test. Sometimes repeating the Dix-Hallpike test, and doing it a little more quickly will produce a positive test when the initial one was negative. If that again was negative for the typical nystagmus, I would think about possible spontaneous resolution of BPPV.
This is the most entertaining lesson on posterior canal BPPV I have ever seen! I hope to see more of Mr. Glaucomflecken!
You're really a great teacher. I've always been really confused on how to do the Dix Hall Pike and Epley and how to tell the difference between BPPV and Vestibular Neuritis/Cerebellar Stroke. I've learned so much and don't get a panic attack when someone shows up with dizziness as the chief complaint in primary care.
Wonderful explanation.I am here after reviewing Vertigo and see that I have been interpreting my Hallpike test incorrectly for years. I think the rotational component of the nystagmus is to blame for the common error of thinking horizontal nystagmus is the more common response to a dix hallpike. I frequently have my patients focus on a point on a wall after they lie down and I seem to point to a spot that has them gazing somewhat downward. This has probably accentuated the rotational nystagmus as you describe and has caused my confusion. Thank you for producing such great content.
Wow this is iconic. Brilliant!
I just discovered your channel and was humbled by my lack of knowledge on nystagmus. Thank you! I wonder what makes you Ottowanians so prolific on your rules and physical exam teachings. An earnest desire to save time and money and get the right diagnosis despite not making somebody broke I presume! From Denison TX - Home of the $9000 CT scan done several times daily.
Ian Stiell, Jeff Perry, Christian Vaillancourt, Venkatesh Thiruganasambandamoorthy, Jason Frank and many more who I count as friends and colleagues have helped inspire me to make my videos to help people learn vertigo. So much so, that at the age of 63, I will soon be an associate professor, something I though I would never attain.
Bravo Dr. Johns and eye guy.
It's so cool! Thanks a lot
well done, love it. Thanks😀😀😀👍👍👍
Thank you for this hilariously accurate video! We see this quite a bit and hope that better educational tools and training can finally get the basics of the vestibular system known to all diagnosticians. Keep up the awesome work and let us know if we can help in any way!
Great video.. Thank you dr. Johns..
I'm getting treated in the morning, this video made me smile, I'm so scared
That is why it doesn matter which maneuver you perform, whether is dix hallpike, head role test or Semont! What matters is the direction of nystagmus it produces!
can you please go through a case of vestibular neuritis with a focus on how you would document the findings for right and left sided please.
Plan on doing that soon!
Awsome! 👏
Great video. Truly grateful for the work you've done in this field. Had a patient that had a few episodes of vertigo (all triggered after bending over or turning in bed) that lasted under a minute. Dix-Hallpike was negative and vertigo has not returned but continued to have residual but improving dizziness for a week or so (especially in morning). No nystagmus with fixation but upon exam, when asked to follow finger, 1-2 beats away from the direction of finger; regardless if gazing left or right, solely based on direction of pursuit (in this case beats in opposite direction of pursuit; beats right if pursuit towards left and visa versa). Any immediate thoughts? Catch up saccades?
Really hard to say.....I expertise is limited to teaching those who don't know very much about vertigo, a little bit of vertigo.
@@PeterJohns I understand thank you. It's almost as though they are tracking beyond my finger and then correcting back to the finger. If anything pops in your head...
@@PeterJohns do you have any info on bppv with nystagamous in the beginning but not anymore lasting longer than 2 months and in both ears?
Love it! I laughed out loud!
wow this was awesome
is it possible to have bppv without nystagmus?
Yes, it's called subjective BPPV. There is some controversy about how often it occurs. I feel it occurs quite rarely. Others think it is not rare.
@@PeterJohns AAFP Volume 95 Number 3 February 1, 2017- it says if Dix Halpike is negative for nystagmus, consider orthostatic hypotension. Is that right?
@@remedamasco1343 Well, yes. But those patients will generally describe dizziness when going from lying or sitting to standing and not from turning over in bed or lying down in bed. And their blood pressure should drop if you take it lying and standing.
If a patient has the typical history of BPPV, (no central features) and says it's when they rollover or lye down in bed, and yet their Dix-Hallpike test is negative, I'd do a supine roll test. ua-cam.com/video/VRjRTnIw9YE/v-deo.html
If that was also not producing the typical nystagmus of HC BPPV. then I would repeat the Dix-Hallpike test. Sometimes repeating the Dix-Hallpike test, and doing it a little more quickly will produce a positive test when the initial one was negative. If that again was negative for the typical nystagmus, I would think about possible spontaneous resolution of BPPV.
Great
Cute