How to look very carefully for nystagmus by using a blank piece of paper

Поділитися
Вставка
  • Опубліковано 4 жов 2024

КОМЕНТАРІ • 47

  • @awaizy
    @awaizy Рік тому +4

    Thank you for explaining the paper trick, this is super helpful

  • @victorgarcia-su8gn
    @victorgarcia-su8gn Рік тому +2

    Hello, Dr. Johns. I am a resident at an otorhinolaryngology service from an university hospital at Rio de Janeiro. Your channel helped me a lot during my first year of residence. I would like to thank you for your enthusiasm in sharing your experience with us. I am happy to know that even after your retirement you will continue to spread knowledge and dedicate yourself to something that pleases you so much. You inspire me.

    • @PeterJohns
      @PeterJohns  Рік тому +3

      Thank you so much. It means a lot to me. If you make vertigo an area you care about in your career, it will be the greatest thanks I can get.

  • @britojunior5703
    @britojunior5703 Рік тому +3

    Thanks a lot! I am a general clinician in Brazil and we have nota many vídeos about vertigo in portuguese. I have seen a lot of vídeos about this theme in english, but that one was awesome! Thanks.

    • @PeterJohns
      @PeterJohns  Рік тому

      Glad you liked them. I have a lot of other ones you might want to look at. www.youtube.com/@PeterJohns/videos

  • @entwritescode6281
    @entwritescode6281 8 місяців тому +1

    Thank you for your videos. I am an ENT from the Philippines and I've been occasionally going back to your channel to reeducate myself on HINTS. I've recently had an 80/F who presented with hours of vertigo accompanied by vomiting, no central features. I did the HINTS exam but I forgot that nystagmus is required. Although I thought I saw a refixation saccade, I'm glad to have stumbled upon this video addressing exactly what I may have been doing wrong - I kept constantly asking her to fixate on my nose. Thanks again! More power to your channel! You are really doing a great service and helping lots of clinicians from the world over by publishing these high - quality, straight - to - the point educational videos. :) God bless Dr. Johns :)

  • @aikival
    @aikival Рік тому

    Thank you for this simple but very helpful tip. Great video!

  • @jeekid
    @jeekid Рік тому

    One again a great video! Thank you for continuing teaching even after you retire from clinical practice.

  • @orandaxi
    @orandaxi 8 місяців тому +1

    Your videos have helped me in my medical practice. Thanks!

  • @monicamichael4748
    @monicamichael4748 Рік тому

    I found your videos extremely helpful. Thank you for continuing to educate us even after you retire!

  • @ahmedfarag1336
    @ahmedfarag1336 Рік тому +2

    Hi dr johns, otolaryngologist here 👋, sir, I am on a mission to make you famous in Egypt 🤝😀, many thanks for your effort ❤🌷

  • @lemaskamaz2193
    @lemaskamaz2193 Рік тому

    Your videos are appreciated. Use them for the emergency neurology department

  • @jlynno111
    @jlynno111 Рік тому

    FASCINATING... I wondered where you were going with the blank piece of paper. Thanks.

  • @pdmof
    @pdmof Рік тому

    Thanks Peter, very informative and helpful videos for all things vestibular.

  • @ahmedsigad3158
    @ahmedsigad3158 Рік тому

    Very educational and informative. Really helps with ENT exam preparation

  • @chih_yungkuo9311
    @chih_yungkuo9311 11 місяців тому

    ❤❤❤ "As fabulous as always! Love your presentation. Many thanks.❤❤❤

  • @rajrigby8385
    @rajrigby8385 Рік тому +2

    would an arrow protruding from the eye, aid in detection of subtle nystagmus? Sadly the Bayeux Tapestry doesn't specify.

    • @PeterJohns
      @PeterJohns  Рік тому

      Based on this tiktok, I'd say yes.
      www.reddit.com/r/interestingasfuck/comments/10afotj/nice_demonstration_of_how_our_eyes_move/
      He shows the difference between pursuits and saccades very nicely, although the technology has been refined since 1066.

  • @Zehh35
    @Zehh35 Рік тому

    That was awesome!

  • @TheMhmodm
    @TheMhmodm Рік тому

    We wating for this good Guide video. Thank you.

  • @philipjansen6107
    @philipjansen6107 10 місяців тому +1

    Thank you!

  • @alfredopampanga9356
    @alfredopampanga9356 Рік тому

    Excellent exposition Where were you when I was beset with talentless teachers ?

  • @reyespalacios24
    @reyespalacios24 5 місяців тому

    Thx very much! from Chile

  • @deepavalame6690
    @deepavalame6690 Рік тому

    Thank you so much for this practical tip Sir

  • @tranyen6249
    @tranyen6249 Рік тому

    Thank you so much! It's so helpful

  • @stepangevorgyan2811
    @stepangevorgyan2811 8 місяців тому

    Thanks for video, it was very useful.

  • @ScienceInMedicine
    @ScienceInMedicine 6 місяців тому

    Amazing!!

  • @bossibozz3528
    @bossibozz3528 Рік тому

    This some good stuff

  • @anastasiiatereshenko204
    @anastasiiatereshenko204 5 місяців тому

    Thanks!!!

  • @Kasa-kc7vp
    @Kasa-kc7vp 4 місяці тому

    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???

    • @PeterJohns
      @PeterJohns  4 місяці тому +2

      Stating "overall neurological status was unremarkable" is often the first step in missing s dizzy stroke.
      "weak" focal weakness?
      "dysatria" Not a word.
      "HINST". It's HINTS
      "positive head impulses test". So was a refixation saccade, seen? And on turning the head quickly to the left or right or both sides?
      "no auditory symptoms" Was a bedside test of hearing performed? Sometimes a patient is so distress with their vertigo they don't notice the loss of hearing indicating an AICA stroke.
      "since several days has passed, no CT brain was ordered". CT scans cannot rule out a posterior circulation stroke. However, the longer the patient has been symptomatic, the higher the chance it might show something. Perhaps a CT done the day of admission would have showed something, perhaps not. Doing a CT head is not wrong in this scenario, as long as you don't think that a negative one rules out a stroke, and you try and arrange an MRI with DWI as soon as possible.
      And now the big finding: "patient could not stand without support". Patients with vestibular neuritis rarely are unable to stand without support. And patients with vestibular neuritis will be starting to cover after 2 days and should be able to stand and walk unaided. And patient with posterior circulation strokes can sometimes walk without support. See the video of this patient with a posterior circulation stroke.
      ua-cam.com/video/MgzhbsxzBdA/v-deo.html
      So it's not a binary finding. That is, it's not "can't walk unaided = central" and "can walk unaided = vestibular neuritis".
      It's more "can't walk unaided= rule out central" not matter what the HINTS exam shows(but it still could be a bad vestibular neuritis in the first day or two)
      and "can walk unaided = more likely to be vestibular neuritis" but screen for all central features, and apply the HINTS exam including bedside test of hearing. before making the diagnosis.

  • @CherylAllin
    @CherylAllin Рік тому

    Both women; Do you see a prevalence of vertigo in women who may be in peri or full menopause? I had recurring BPPV that disappeared once I started menopausal hormone therapy. I certainly don't miss it!

    • @PeterJohns
      @PeterJohns  Рік тому

      Vestibular migraine is very common in perimenopausal women, and often seems very positional. I have a video on that.

  • @brianwerner9141
    @brianwerner9141 9 місяців тому +1

    Why is there a torsional component to this beat?

    • @PeterJohns
      @PeterJohns  9 місяців тому +3

      Most cases of vestibular neuritis are affecting the superior branch of the vestibular nerve. This branch brings signals from the horizontal and anterior semi-circular canals. It's the abnormal input from the anterior canal that gives most patients with vestibular neuritis the torsional component.

  • @verselmao
    @verselmao Рік тому

    neat

  • @junzilla13
    @junzilla13 Рік тому +1

    How can I submit for CME?

    • @PeterJohns
      @PeterJohns  Рік тому

      Ha, not from this channel. This is all free open access medical education.

  • @adamabdul-karim8782
    @adamabdul-karim8782 Рік тому

    How do we differentiate from end gaze nystagmus?

    • @PeterJohns
      @PeterJohns  Рік тому +2

      Watch this video. Happy to answer any question you have afterwards. ua-cam.com/video/4KBlzEHk-N8/v-deo.html

    • @adamabdul-karim8782
      @adamabdul-karim8782 Рік тому

      @@PeterJohns cleared it up beautifully!

  • @k.c.8658
    @k.c.8658 Рік тому +1

    Congratulations on retirement!

    • @PeterJohns
      @PeterJohns  Рік тому +4

      Thanks! So far, not working is more fun than working. And more time for teaching vertigo, which is not work to me!

  • @boogsrocks5135
    @boogsrocks5135 9 місяців тому

    You poor girl

  • @johnkuo855
    @johnkuo855 Рік тому

    Congratulations on retirement!