Thank you very much for all your videos, they are so relevant and important!!
@tonyf315
5 жыл бұрын
I have a family practice resident shadowing me in my PT practice next month and will definitely suggest this and your other videos as part of my tutoring!
@tonyf315
5 жыл бұрын
as a side note, I'd like to mention that I have learned that there is an advantage to having to patient look toward the downside ear if you are examining without the aid of Frenzel Lenses or IR video goggles-the vertical component of BPPV nystagmus can be suppressed with visual fixation whereas the rotary component is much less easy to do so. Purposely biasing gaze to highlight the rotary nystagmus may let an examiner see nystagmus where they otherwise may not see anything.
@PeterJohns
5 жыл бұрын
That's an interesting point. I haven't noticed people suppressing the vertical component myself. I prefer to have the patient change gaze from ear to ear. Makes me think of Barany every time. :)
@tonyf315
5 жыл бұрын
@@PeterJohns I will most often use that trick if, in the Dix-Hallpike, the patient is subjectively dizzy but I'm not seeing nystagmus-if I have them look in the direction of the down-side ear I will often pick up (often subtle) rotary nystagmus!
@PeterJohns
5 жыл бұрын
@@tonyf315 Related to a question from Douglas Quaid, how often do you see purely subjective BPPV? I've only seen one case that i can recall.
@tonyf315
5 жыл бұрын
@@PeterJohns This is funny because as I was thinking of my answer to this question I was estimating in my head 1/4 to 1/3 of the time I think someone has BPPV they have subjective findings w/o nystagmus, then I saw your reply below where the paper from Balatsouras where it was claimed a quarter of the BPPV he saw were subjective. I speculate practice setting may influence this: You're in an ED where people are severely symptomatic enough to seek emergency attention, wheras I am in an outpatient PT setting where I will see acute presentation like you but also many that are much more chronic or subtle. Just a guess I know but I think there's logic to the idea.
@PeterJohns
5 жыл бұрын
@@tonyf315 Yes, probably true. Would it be true that you tend to see less HC BPPV as the spontaneous resolution is shorter in that BPPV variant? The last 3 cases of BPPV I've seen have been HC BPPV.
@custom8888
5 жыл бұрын
Thank you Dr. Johns!
@hellomicray
3 жыл бұрын
Thanks Dr Peter John I like your clear idea of BPPV explanation But I wonder is your illustration with SO correct or not My idea is that Nystagmus is the fast phase ( representing the muscle that is inhibited initially then re activate during corrective saccade) So in posterior canal BPPV Initially SUP obliq is activated at slow phase which show downward initially Then corrective phase ( fast phase) Inferior obliq excited and causing upward vertical and tortional nystagmus It applied to your demonstration well too When hall pike left side Eye looking to downward ear - IO also show rotational nystagmus When looking at nose side - IO show vertical upward nystagmus Please correct me if I am wrong Thank you very much for your KZitem channel which helps me a lot ! Thank you
@PeterJohns
3 жыл бұрын
Yes, this may be correct. I'm not a vertigo expert, or neuro-ophthalmologist. I don't think this makes a huge difference in the explanation about the nystagmus seen in PC BPPV though....
@TheMarlamer
3 жыл бұрын
@@PeterJohns thanks for your video they are good
@pinkpanther275
5 жыл бұрын
Amazing job and extremely helpful video. Greetings from Ukraine.
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