Just want to say that i'm brazilian and i am deeply grateful for your content, thanks a lot.
@sunving
3 жыл бұрын
Thank you Dr Peter John!
@conveyorbeltz1
4 жыл бұрын
What a great video Dr Johns! Thank you for sharing.
@eyalokin
4 жыл бұрын
Great material as always!! Thank you Doc!!!
@AzizOsail
4 жыл бұрын
great job continue and keep us with new
@TheFastman112
4 жыл бұрын
Thanks for the video, very informative. Could you please make a video about multicanal-BPPV?
@PeterJohns
4 жыл бұрын
My focus is to teach vertigo novices how to evaluate the undifferentiated vertigo patient. I have only seen multicanal BPPV a few times, so all I would say is that the principle is to first treat the canal and type which seems to be the most symptomatic on bedside testing. And multicanal BPPV is most commonly seen after head trauma.
@tonyf315
4 жыл бұрын
another gem!
@mariopadilla3086
3 жыл бұрын
I think that the patient of this video if she has otoliths in the horizontal canal she could also have otoliths in the cupula, then she can have a strong and short geotropic nystagmus due to canalolithiasis and after a apogeotropic nystagmus by a cupulolythiasis of the same canal that lasts more, both relieves with gufoni maneouver if during the maneouver the cupulolithiasis is transformed to canal lithyasis. thanks, I only have seen a patient with multicanal vppb, with a residual horizontal canal vppb after a epley meneouver-
@PeterJohns
3 жыл бұрын
There are a lot of rarer things about BPPV we don't know for sure exactly what is happening. I think this is one of those. Thanks for your comment!
@aragonthebrave
4 жыл бұрын
Hello sir....wanted to ask this exact question....have been seeing quite a few horizontal bppv patients with spontaneous nystagmus and I kept remembering your statement in an earlier video contradicting this...but thanks sir for clarifying.....
@jerrypotter9070
4 жыл бұрын
Thanks Dr Johns for your effort. Where can I find those algorithms or charts shown in your video? I like to download.
@PeterJohns
4 жыл бұрын
www.cmaj.ca/content/192/8/E182 This is an open access article. Also it's the 9th edition of Tintinalli's Emergency Medicine. Also see this video kzitem.info/news/bejne/rq2Y136shnagoYo has it at the 2:19 time mark.
@jerrypotter9070
4 жыл бұрын
@@PeterJohns Thanks
@ahmedthamir9531
2 жыл бұрын
💞💞💞💞💞💞
@ryanlian8132
3 жыл бұрын
Hi Dr Johns, thanks so much for these videos! I'm a physiotherapist in an Australian ED and your videos have really helped me! I saw a patient the other day with pseudo-spontaneous nystagmus and geotropic R lateral canal BPPV. But my question is, if these patients are getting pseudo-spontaneous nystagmus in sitting, shouldn't we see "fatiguable" pseudo-spont nystagmus? I had the frenzel goggles on my patient for ~2 minutes in sitting and the nystagmus didn't seem to fatigue. Thanks!
@PeterJohns
3 жыл бұрын
Good question. I haven't seen pseudo-spontaneous nystagmus a lot, but apparently you can tilt the patient's head forward and it should stop.
@kehindekolapo6986
Жыл бұрын
@@PeterJohns Is it possible to have bi-directional horizontal spontaneous nystagmus in peripheral vestibular disorder?
@PeterJohns
Жыл бұрын
@@kehindekolapo6986 bi-directional gaze evoked you mean? That is, the patient looks to the left and it beats to the left, and the patient looks to the right and the nystagmus beats to the right? That is central. But don't confuse it with end gaze nystagmus. kzitem.info/news/bejne/k3ugmZ6toKiogIo
@stevestanley2389
4 жыл бұрын
Great video!One question- which direction you do the Gufoni maneuver if the nystagmus changes direction?Toward the good or the other one?
@PeterJohns
4 жыл бұрын
Watch this video. kzitem.info/news/bejne/t4iguIikgqlqjHo If you have questions after that, I'm happy to answer them.
@melanieleclerc6580
3 жыл бұрын
I was wondering for the girl with vestibular neuritis, if we don't know if it's a pseudo or spontanous nystagmus, surely she would have had a positif head impulse test and with an horizontal canal the head impulse test would be negative so why do the supine roll test before doing the head impulse test? Thanks!
@PeterJohns
3 жыл бұрын
It's a good point. I actually didn't do the supine roll test on her until after I did the HIT, which was positive as shown. It appears in the study I quote, that the HIT was not on patients before referring them to ENT. Most emergency physicians are not comfortable with it yet. I only did the supine roll test in my patient to see what would happen when I did it.
@melanieleclerc6580
3 жыл бұрын
@@PeterJohns thanks again for the answer! I appreciate your vidéo so much!
@jeekid
2 жыл бұрын
Hi, Peter. In the first case, I think your Gufoni maneuver begun with her right ear down. How about the second part? Did your turn her head down (treat as left geotropic hc-BPPV) or up? (treat as right apogeotropic hc-BPPV) I am just wondering that her affected ear might be changed by the direction change of her nystagmus.
@PeterJohns
2 жыл бұрын
I turned her head down, as a left geotropic HC BPPV.
@aragonthebrave
4 жыл бұрын
One simple question sir..often it is difficult to really distinguish if it's apo or Geo in patients having "feeble" nystagmus on both sides...any particular tricks to identify ??
@PeterJohns
4 жыл бұрын
Video it, and examine it closely if you aren’t certain about direction of the nystagmus.
@mohammadahmad9486
3 жыл бұрын
According to pubmed: Determination of the involved ear is sometimes difficult due to rather symmetrical responses, especially if the induced nystagmus is not recorded. In these instances, other findings may provide clues toward determining the affected ear: In HC-BPPV, nystagmus may be induced by lying supine from the sitting position [lying-down nystagmus (LDN)] or by bending the head forward while sitting [head-bending nystagmus (HBN)]. (Up to 80% of HC-BPPV cases, LDN and HBN are in the opposite direction) In geotropic HC-BPPV: HBN beats mostly toward the affected ear, while LDN is directed mostly toward the healthy ear. In apogeotropic HC-BPPV: HBN beats mostly toward the healthy ear, while LDN is directed mostly toward the affected ear.
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