An overview of how to approach a patient presenting with vertigo, including a discussion and demonstration of the HINTS exam. Thanks to folks on Twitter for providing feedback on the diagnostic algorithm! #vertigo #dizziness #HINTS
Welcome to my new subscribers, including those who found me in the past week from my coronavirus video! If you are hoping for more coronavirus news, I'll be posting a follow-up video in a few days.
Sir, thank you for this video. I am really having a hard time learning ENT concepts due to the amount of information we are equired to read. The approach is straight forward and very helpful.
Thank you so much for all your videos, but specifically these approach to videos, yours are one of the only few places we can find actual practical approach, it seems everyone just assume we will learn it in the hospital, yet I mostly feel clueless when am there because theory is very different from what is done in practice.
Another great video! I have great difficulty in distinguishing vertigo from lightheadedness in my patients- I usually ask them what they were doing when the sensation came along and can usually rule out vasovagal syncope, orthostatic syncope and situational syncope. But I'm always worried about a cardiogenic syncope in patients complaining of dizziness coming on spontaneously and find it very hard to not order further cardiac work up. Any tips?
Good video ! A few comments - the notion that a clinician reliably can distinguish between lightheadedness (presyncope) , vertigo and unbalance has largely been put into doubt by Kerber et al and Newman-toker, and edlow. One may be more probable than the other , but one should be vary to rely to much on this part , as there is a big overlap . More important is the focus on triggers and timing (TITRATE or ATTEST method ) - The section on (true) vertigo could possibly become even better if it was put into the categories suggested by Edlow and others : tEVS, sEVS and AVS - I would emphasize to do the nystagmus test of the HINTS first . If you do not se nystagmus , you’re done and cannot move in in the HINTS as it should only be carried out on AVS patients with spontaneous / gaze evoked nystagmus . Otherwise the HIT will be always false-negative (indicating central cause)
I have a couple questions as a follow-up to this extremely informative video: 1) will central vertigo ever be episodic, or or if it comes and goes can I be pretty certain it's peripheral? 2) do you have a concise description for an abnormal dix Hall pike? (Does any nystagmus indicate a positive test, or do different directions mean differing things?) 3) With a NORMAL dix Hall pike but episodic vertigo and normal neuro exam, would this suggest non-BPPV peripheral vertigo? Thanks!!
OK, so at a former job, I used to spend hours with my head positioned diagonally, being that I'm tall and have a long neck. The chair was not adjusted to my height. Often I would get dizzy and have a hard time keeping my balance once I left the office and during the break. Perhaps using earphones and taking collagen worsened it. I tried the Epley and Hallpike technique and it seemed to work somewhat.
i’m curious, (and i’m obviously not looking for medical direction, but just curious) - i used to sometimes get a dizzy (vertigo) sensation when i got up from being seated a few hours. if i ignored it, it’d go away really quick. but, if i took a breath, and stretched, it’d lead to a near faint. i figured as long as i made sure i was leaning back toward the seat, it was fine - and i enjoyed the momentary high. i was thinking about it while watching the video and it hasn’t happened in a good 10 years, but againl (so from roughly age 16-27), i enjoyed the high, so kinda curious what may’ve caused this/made it disappear.
@ass it’d happen when I stood up, I’d experience an almost faint - it’d happen when I got up and took a deep breath and stretched - if I wanted it to not happen I’d just sit back down). Head movement/inner ear didn’t seem to impact this. it’d last maybe 5 seconds (though that’s hard to judge since I wouldn’t know to look at the time before it came on).
@@testuser2709 same here. It could be the tap water of the area you inhabited. Perhaps it was not well filtered. They say tap water can contain female hormones ever since the invention of the pill for the day after.
Few years ago, you asked which format do we like the best. At that time, I said you standing in front of the text. You said there were some technical issues to solve first to do this way. Few months later you started doing this format. I always wonder if I had any influence in that. You are the Best Eric Strong
How do you differentiate bidirectional and unilateral nystagmus. The pupils go left and right in both cases. Seems awfully subjective in the real world. I’m not sure if I could use this test confidently to rule out central vertigo.
I had vertigo suddenly 2 weeks ago on turning my head in either direction. The physiotherapist said I have BPPV and did a head manipulation for me yesterday. However, my head spinned even more last night when I lied on my bed. The spins were larger than the spins before the head manipulation. What went wrong?
I get Ménière's symptoms _directly_ associated with inadequate thyroid replacement (in fact I can make it come and go by altering dosage). My mom has the same. There is an associated hearing loss as if my ears are full of water (everything is unpleasantly loud but indistinct), accompanied by tinnitus and increased blood pressure. All of this goes away when thyroid dosage is correct. (MRI was negative.)
I hadn't previously heard of an association between symptoms of Meniere's and control of hypothyroidism, but a literature search just found this: www.ncbi.nlm.nih.gov/pubmed/27437251. Thanks for your comment!
To Pros and Cons. First the con: confusing me with initially claiming an abnormal HINTS suggests peripheral cause but later contradicting it. Pros: Everything else, esp. the short exam demos :)
I don't want to say no because somewhere out there is probably a person whose angina or arrhythmia triggered vertigo, but that would be highly unusual.
Surprisingly, despite both how common migraines are and the fact that it's 2022, we still don't well understand the pathogenesis of migraines. However, the once popular vascular theory of migraines is no longer considered to be their likely underlying mechanism. From the UpToDate article on migraine pathophysiology: "Cortical spreading depression is hypothesized to cause the aura of migraine, activate trigeminal nerve afferents, and alter blood-brain barrier permeability. Activation of the trigeminovascular system plays a central role in the pathophysiology of migraine, including the onset of neurogenic inflammation, which is linked to the pain of migraine. Sensitization, a process in which neurons become increasingly responsive to nociceptive and non-nociceptive stimulation, is likely responsible for many of the clinical symptoms of migraine."
