Doc, I work in a small rural ER in Ontario, and I just want you to know that this video parted the clouds and spoke to my soul. Thank you for making this content.
Thank you so much Dr Peter for these awesome, informative videos. As a young audiologist in Turkey, I am very happy to be working in the same field as you. I hope we have the opportunity to meet one day.
Why do doctors not have knowledge of this. I have gone to specialists over a 2 year time frame and never gotten the explanation you provided. I've done extensive research myself to come up with answers. I've even taken printed out material on this vestibular issue to a new family doctor, I found her to be very interested in the information I gave her. Thanks for yours
I became a doctor in 1984, so I do have a historical perspective. The information about vertigo given to family MDs and emergency MDs over the past 4 decades has often been incomplete, incorrect, or misleading. This made it very difficult to make a diagnosis of even the common causes of vertigo. In addition, dizzy patients can suffer from many different non-serious causes, and sometimes from deadly causes that can look very similar to non-serious causes. Lastly, patients through no fault of their own often have difficulty describing the sensations they are feeling, and doctors find their vagueness frustrating. This all lead to the very common attitude of many doctors of fear and dislike of dizzy patients. There has in the last 20 years been very useful information available to vertigo interested MDs about BPPV, vestibular neuritis, strokes presenting as dizziness, vestibular migraine and other conditions. However, the overwhelming majority of physicians still harbour the long standing fear and dislike of dizziness, in part because of their lack of understanding of how to properly assess them. The good news is that there is starting to be more physicians who have recognized the deficit in their skills of assessing dizzy patients and are starting to reach out to educational materials that provide good information on vertigo/dizziness. I would count my UA-cam channel as one of those resources. Let's hope that vertigo education in all physicians will get better in the coming years, to the betterment of the patients and practice satisfaction for the doctor.
@@PeterJohns I'm really doing much better it has taken the better part of 2 years. It all began in February of 2022 after receiving the Covid booster shoot. I know in my gut the two events are connected.
Wait?! You're an ED doc AND you see like a nice guy who likes to teach? I think I've found a unicorn! Thanks for the video doc, it really helped clear things up regarding when to use this and when NOT to use it.
Recently my eyes start to move side-to-side when I'm talkin for no apparent reason. I don't have any illnesses I'm aware of. I search the symptom on youtube and this video show up
These videos are excellent. If you don't mind I have a questions about patients without nystagmus. In patients who present with dizziness but screen negative for central features and it isn't BPPV or something like vestibular migraine/ menieres or a medical cause, and don't have nystagmus what is your usual approach? Obviously if they have lateralopulsion, or ataxia or are unable to walk they're quite high risk (as in Acute Imbalance Syndrome from Machners article) and should get a stroke work up but if they are able to walk do you think they are low enough risk to treat symptomatically and discharge them to follow up? Or do you use stroke risk factors/ABCD2/ something else to help in your decision?
Machner did not define AIS beyond "persistent dizzy, imbalance, but no nystagmus". So as long as their gait is objectively different than usual, I would work them up for stroke. Stroke risk factors would play a part in decision making, yes. But low risk (ABCD2of 3 or less) AIS patients had a higher percentage of abnormal MRI's than HINTS central patients (27% vs 21%)
@@PeterJohns thank you for the prompt reply and your excellent videos which have helped my approach to vertigo so much. I asked Dr Machner before about the acute Imbalance subgroup he said "All patients who reported a new dizziness/Imbalance and revealed a persistant unsteadiness in stance and/or gait (ataxia, lateropulsion or complete inability to walk) were assigned to the "acute Imbalance" subgroup." and in the patient who fit that regardless of abcd2 or anything else I have a very low threshold for investigation. I was more curious about those whose gait is normal but still report feeling dizzy, but without objective findings and without imbalance or gait problems. My feeling is that this is a pretty low risk subgroup and can probably be discharged but wanted to know if you had any advice or caveats to that?
@@BoredMedic I think your approach is bang on. Of course there are patients who are high risk for badness with any symptom. (Minor head injury on a thinner, or known active malignancy etc.). But your average patient who screens negative for central features, with isolated dizziness only, no nystagmus, no difficulty walking, then yes, I think they are very low risk, and likely safe for discharge. I don't know of a study that shows this, but I believe it to be true.
Sir you are the best teacher for vertigo.
Doc, I work in a small rural ER in Ontario, and I just want you to know that this video parted the clouds and spoke to my soul. Thank you for making this content.
And your comment warmed my heart!
Thank you so much Dr Peter for these awesome, informative videos. As a young audiologist in Turkey, I am very happy to be working in the same field as you. I hope we have the opportunity to meet one day.
Sharing w my ED medical resident colleagues this Thursday! Thank you for a great concise summary!
As a young house officer beginning a primary care rotation in NZ, many thanks to you sir!
Doc thanks so much, greetings from The Netherlands. (in Europe)
Why do doctors not have knowledge of this. I have gone to specialists over a 2 year time frame and never gotten the explanation you provided. I've done extensive research myself to come up with answers. I've even taken printed out material on this vestibular issue to a new family doctor, I found her to be very interested in the information I gave her.
Thanks for yours
I became a doctor in 1984, so I do have a historical perspective. The information about vertigo given to family MDs and emergency MDs over the past 4 decades has often been incomplete, incorrect, or misleading. This made it very difficult to make a diagnosis of even the common causes of vertigo. In addition, dizzy patients can suffer from many different non-serious causes, and sometimes from deadly causes that can look very similar to non-serious causes. Lastly, patients through no fault of their own often have difficulty describing the sensations they are feeling, and doctors find their vagueness frustrating. This all lead to the very common attitude of many doctors of fear and dislike of dizzy patients.
There has in the last 20 years been very useful information available to vertigo interested MDs about BPPV, vestibular neuritis, strokes presenting as dizziness, vestibular migraine and other conditions. However, the overwhelming majority of physicians still harbour the long standing fear and dislike of dizziness, in part because of their lack of understanding of how to properly assess them.
The good news is that there is starting to be more physicians who have recognized the deficit in their skills of assessing dizzy patients and are starting to reach out to educational materials that provide good information on vertigo/dizziness. I would count my UA-cam channel as one of those resources.
Let's hope that vertigo education in all physicians will get better in the coming years, to the betterment of the patients and practice satisfaction for the doctor.
@@PeterJohns I'm really doing much better it has taken the better part of 2 years. It all began in February of 2022 after receiving the Covid booster shoot. I know in my gut the two events are connected.
@@Lovemy911 I'm sorry, but I can't comment on your case. I hope you recover soon.
Excellent video.
Thank you very much for the video information :)
Wait?!
You're an ED doc AND you see like a nice guy who likes to teach?
I think I've found a unicorn!
Thanks for the video doc, it really helped clear things up regarding when to use this and when NOT to use it.
Yeah, just saw a case where someone HINTS was done on a patient with no nystagmus. Confusion ensued.
Another excellent video for teaching. Thanks so much.
Thank you for this!
Thank you! Amazing video!
Excellent, thank you.
Thank you very much!
Recently my eyes start to move side-to-side when I'm talkin for no apparent reason. I don't have any illnesses I'm aware of.
I search the symptom on youtube and this video show up
Nice👍
These videos are excellent. If you don't mind I have a questions about patients without nystagmus. In patients who present with dizziness but screen negative for central features and it isn't BPPV or something like vestibular migraine/ menieres or a medical cause, and don't have nystagmus what is your usual approach? Obviously if they have lateralopulsion, or ataxia or are unable to walk they're quite high risk (as in Acute Imbalance Syndrome from Machners article) and should get a stroke work up but if they are able to walk do you think they are low enough risk to treat symptomatically and discharge them to follow up? Or do you use stroke risk factors/ABCD2/ something else to help in your decision?
Machner did not define AIS beyond "persistent dizzy, imbalance, but no nystagmus". So as long as their gait is objectively different than usual, I would work them up for stroke. Stroke risk factors would play a part in decision making, yes. But low risk (ABCD2of 3 or less) AIS patients had a higher percentage of abnormal MRI's than HINTS central patients (27% vs 21%)
@@PeterJohns thank you for the prompt reply and your excellent videos which have helped my approach to vertigo so much. I asked Dr Machner before about the acute Imbalance subgroup he said "All patients who reported a new dizziness/Imbalance and revealed a persistant unsteadiness in stance and/or gait (ataxia, lateropulsion or complete inability to walk) were assigned to the "acute Imbalance" subgroup." and in the patient who fit that regardless of abcd2 or anything else I have a very low threshold for investigation. I was more curious about those whose gait is normal but still report feeling dizzy, but without objective findings and without imbalance or gait problems. My feeling is that this is a pretty low risk subgroup and can probably be discharged but wanted to know if you had any advice or caveats to that?
@@BoredMedic I think your approach is bang on. Of course there are patients who are high risk for badness with any symptom. (Minor head injury on a thinner, or known active malignancy etc.). But your average patient who screens negative for central features, with isolated dizziness only, no nystagmus, no difficulty walking, then yes, I think they are very low risk, and likely safe for discharge. I don't know of a study that shows this, but I believe it to be true.
Hints plus peripheral or central result
What if you have congenital nystagmus? 😭
This would make it difficult certainly.