Strokes & The Rule of 4s || USMLE

​​SUPPORT/JOIN THE CHANNEL: / @dirtymedicine
My goal is to reduce educational disparities by making education FREE.
These videos help you score extra points on medical school exams (USMLE, COMLEX, etc.)
For educational purposes only; NOT medical or other advice.
Some videos contain mild profanity and hyperbole solely used to assist with memorization. Viewer discretion advised.
Opinions are entirely my own.

[@DirtyMedicine]

What you need to take away from this video, AKA, the Rule of 4's!: (1) Divide the CN's up by 4's. They correspond to the sections of the brainstem as you increase in number by 4. For example: CN 1-4 (Midbrain), CN5-8 (Pons), CN9-12 (Medulla). (2) Then, CN's that divide equally into 12 are MIDLINE and those who do NOT divided equally into 12 are LATERAL. For example: CN 3, 4, 6, and 12 are all MIDLINE. CN 5, 7, 9, 10, and 11 are all LATERAL (you omit the first 2 CNs). (3) Next, determine if the deficit is MOTOR or SENSORY. Motor deficits are midline and sensory deficits are lateral (sensory = side). IF YOU UNDERSTAND THESE RULES YOU WILL NEVER GET A BRAINSTEM STROKE QUESTION WRONG!!!! ***Example #3 was removed from the video**

[@heelofentrepreneurs7788]

DirtyUSMLE your chanel is amazinggg , omg ! I just came across of it and after each video everything seems so simple . thanks for doing it , you just an USMLE angel lol 😁😁😁😁😁

[@shwetadabhi2585]

PRESSURE VOLUME LOOPS ... There's no one else but you who can explain such tough concept of cardio... Please help us with that.

[@MeetGrady]

Thx for the videos! Would be nice if you could cover "headache" and/or "thyroid diseases” (not just hypo-/hyperthyroidism)

[@angelofrevengeable]

High-yield microbiology , please ))

[@hmansaria5632]

Great videos! Could you please pin your comment to the top of the list? A lot of people are commenting regarding the CN XI and XII mix-up in the video. Thanks.

[@SanguineMedical]

The person who came up with The Rule of 4s deserves a Nobel Prize for helping out students worldwide

[@user-eh5wz9bm5h]

agree, Dr peter gates 2005

[@ananyapanigrahi3606]

100% ....i always used to skip this topic before I knew the rule of 4!😅

[@andrewfaus6501]

Also, questions may ask which artery is blocked in the stroke so it's good to know which artery supplies which region of the brainstem. Midbrain = PCA Lateral Pons = AICA Medial pons = Basilar Lateral medulla = PICA Medial medulla = ASA

[@shabanalakhair2984]

Thankuuu so much nicely and in a very easily explained way

[@ehadalbusaidi4779]

thanks for sharing , so sweet

[@hebasiddig7475]

Thanku

[@djiraimadjecalvin3398]

Thanks

[@rumsha_khalid]

Lovely!

[@lilmortyy2480]

I think it's also important to remember that tongue deviations are ipsilateral, meaning they're on the same side of the lesion. Like if his tongue is deviated to the left, the lesion is probably on the left side and vice versa

[@nystagmus]

Waleed Murad yup

[@adityapaudel6016]

“ Lick to the lesion”. This is how i usually remember this. always had hard time remembering that

[@TheSteviebobevie]

Uvular deviation is opposite! I like that "Lick the lesion" mnemonic

[@abramc4739]

T-ongue T-owards the lesion Uvul-A A-way from the lesion

[@mk-wb4yl]

As far as I know 4,7,10 th CN causes opposite site involvement rest has ipsilateral site involvement..... As touge is supplied by 12th nerve so ipsilateral involvement will take palce and uvela is supplied by 10th nerve so contralateral involvement wil take place.......plz correct me if um wrong....

[@collinsnjoku5568]

Made me want to cry; I've struggled with answering cva qs for so long.

[@nunchukgrl2]

I love you. I've read the Rule of 4's, I've watched the Boards and Beyond videos on the Rule of 4's, I've freaked out about the Rule of 4's, and it wasn't until I watched your video that I've been able to just take a deep breath and calm down. Thank you for explaining it so simply and giving examples on how we can apply it.

[@patrickblackwell777]

Spent an entire semester in neuro class and you broke it down better than either of my professors could. Thank you!

[@ramyhiekal5191]

maaaan....God bless you brother...thank you for spreading the knowledge.

[@rowellv6606]

Absolutely brilliant. This cleared it up 1000%. Thank you.

[@zt2552]

Been practicing (as non neuro doc) for years and I just understood stroke lesions now because of this video! Why did I just discover this? Thank you so much 🙏🏻😊

[@walichowdhury370]

You are extremely talented. The way you simplified this was amazing. Thank you

[@dacommander]

Dude you’re a life saver, thank you so much

[@huntercoates7354]

The vignette should say 'he is unable to move his eyes to the RIGHT' as this is a RIGHT sided stroke and CN motor loss is IPSILATERAL (CN6 Abducens in this case - he can't abduct to the right).

[@haiderMJ]

Yep that’s right, I noticed that too. Thank you for reassurance

[@sandeeeyx3]

Wow this was hands down one of the best videos I've watched. Great visual aids and you explained it so simply. THANK YOU SO MUCH!!!

[@sadykhan4763]

Thank you so much !! This is of great help, 5 years of medical school but this single video made it so simple. God bless you !!

[@7ayaat1]

I am truly thrilled! Ur teaching is a blessing!! Thank you!

[@sabaali457]

Just the organization of the nerves has helped so much!!!!! why can't everyone teach this!! Thank you so much!

[@kawlahalarfaj6474]

THIS IS BY FAR THE BEST VIDEO I HAVE SEEN ON THIS TOPIC.. I SPENT HOURS ON MY ANATOMY BOOK WITHOUT A FRACTION OF THE BENEFIT I GOT FROM THIS VIDEO.. THANKS A MILLION !!!!

[@positive_hassan8252]

Thank you so much ,GOD bless you with more wealth , Health and knowledge

[@bellasantie]

AWESOME, JUST AMAZING.. THANKS 🙏🏾 SO MUCH!!!!

[@tineshacooky4498]

OMG thank you, studying for step 3 and I am reviewing the basics

[@merblue4776]

thank u so so so much I am literally unable to describe how helpful that was.

[@medicalstudybuddy2964]

If i could inform medical students and/or physicians of only one medical video out there, this would be it!!

[@IM.MEDICAL]

Thanks for spreading the knowledge! 👍

[@user-mk9hy7eq4i]

You explained the rules of stroke with easy words.Recently in Japan the examinations of medical license have lots of clinical situation questions. It seems to be natural, but in the past this exams was different from those recently. In the past there are a lot of questions with simple facts ,thus it was like a quiz... The age has been changing...

[@anapereira5170]

🙂Muito obrigado pelo que fez pela minha mãe,dá gosto ver todos os seus vídeos doutor. Isso aí ! Até cortar os próprios defeitos pode ser perigoso. Nunca se sabe qual é o defeito que sustenta nosso edifício inteiro.

[@masayuangelanggraini6144]

Thank you, man. You don't know how much it helps me. I am not good with basic neurology. And this helps me tremendously.

[@nystagmus]

9:00 The stroke is medial but you cannot 100% localize it to the pons. CN 3 and CN 6 connect via the MEDIAL LONGITUDINAL FASCICULUS and therefore damage to the MLF can be anywhere from the midbrain to the pons. The stroke might have not hit exclusively CN . But i would guess the pons as well. The second example with CN 12 vs 11 is incorrect however people have mentioned this already OVERALL AMAZINGLY GREAT JOB!

[@cristobalalmendares2645]

Thanks you Dirty, greetings from Habana, Cuba. I hope you continues making videos like this👍

[@ShoaibAhmed-ix5vp]

A big salute to this person who made this I was so dam worried and was hiding always from these topic .thanks to this

[@nouranm1224]

Thank you so much, this is the first time i understand stroke syndromes.

[@AliceNLi]

WHAT A GENIUS.

[@sarahgroleau4127]

Thank you so much, this video is amazing, quick easy, organized and to the point, I LOVE it.

[@adrenaline2288]

True blue

[@soojinlee3527]

I literally breathed a sigh of relief when I saw that you had a video on this...

[@lumiahtisaari148]

This was fantastic!!! What a great explanation! Thank you so much

[@rit2557]

Fantastic!!!!!!!!!!! No words!! Thank youuuuu🙏🙏🙏🙏

[@marthaisabelsiqueirostirad3172]

Excellent video, so clear! thank you!

[@sinduiska190]

Thank you so much for the video,Helpful tips!.I just wanted to point out in The four motor midline syndromes.medial lemniscus isnt motor it is sensory tract

[@humayounamini3343]

hey man, thanks alot , i was all the time freaking out whenever i see stroke question now i feel much more confident ,,,,

[@My_Secret_ArtSketchbook]

SIGNS OF STROKE::: left side neck arm pain, slurry speech, can't smile, face dropping to 1 side, difficult swallowing. REASONS FOR STROKE::: worrying too much, high blood pressure, high diebetes/ sugar levels. CURE/ PREVENTION- diet, exercise. Eat fruits to LOWER blood pressure. For inflammation eat raw root turmeric haldi. Tea bags r giving headaches so can't be trusted. And eating too much sugar and sweetners give dark circles , loss of hair, memory loss. herpes can be caught smoking the hookah pipe. Hepatitis can be cured by drinking 1 glass of coconut water per day.- plz avoid drinking anything straight out of fridge- not good for heart I'm telling you. Lipoma LUMPS gone by fasting for at least 16hrs because fasting eats up cysts n tumours, lipoma lumps, eating omega 3, raw turmeric, drinking more water, exercising, massaging body BEFORE breakfast dinner . Plz AVOID cakes , muffins, doughnuts, fizzy drinks fried foods, soy sauce as they cause LUMPS. GET MOVING- you will notice that tingling sensation on LUMPS after exercising- proof. Also same feeling after drinking fizzy drinks- notice plz LACK OF WATER , CIRCULATION also cause of LUMPS in body. I spent a fortune on homeopathic tablets but to be honest doc put turmeric in those tablets. Surgery never is the cure knew a lady with so many lupms she got so many operations. Never the cure. To prevent strokes eat Apple banana n pears. To lower blood pressure immediately plz eat banana. Fruits can LOWER blood pressure and by drinking more water throughout the day. - plz avoid drinking n eating while standing n walking it's bad for the heart and joints. I eat on the floor/ carpet/ rug. Fibroids can be prevented by Avoiding chicken liver, tomato seeds, white flour so doughnuts cakes white sugars. Plz note too much lack of FERRITIN and IRON in body may cause heart attack so get eating beetroot, spinach carrots plz- avoid for few hours coffee milk, cake, doughnuts, cream, tea ,wholemeal bread, pitta as these STOP iron absorption so not your best friend

[@Alaghbari86]

plz keep going ... brilliant job

[@user-mk9hy7eq4i]

Very simple strategy! Thank you.

[@emilyb5557]

Great video & honest response re mistake! I wish in the UK MRCP they did the same they of putting the named syndrome in brackets. We can be asked Paranauds & need to remember it's X location rather than be able to show we can localise correctly!

[@aasmaa27]

Really helpful!!! Hands down Best video on strokes. Thankyou

[@SimranAgain]

You are a god Dirty! A literal god for making this video!

[@smartaleck05]

this is really good- thanks!

[@arthursaroughian7825]

Appreciate all your help buddy! Wondering if you made videos on rapid histology and biochemistry cases or videos..? Thanks for all you do for Usmle folks Appreciate your time

[@muhammadmahmood734]

best stoke localisation video i have seen so far. thankyou

[@yilinnchia3782]

This is absolutely good !!

[@danktankdragkings7117]

Thank you so very much. I am a 2 major things survivor and 3 subsiquent concussions that I know of. I would love to be a neurologist (I know the material) I just can't afford the school nor do I have the attention span to go to college anymore. I really appreciate having this information available both to understand myself and to follow my passion even if I can't make it a career.

[@My_Secret_ArtSketchbook]

SIGNS OF STROKE::: left side neck arm pain, slurry speech, can't smile, face dropping to 1 side, difficult swallowing. REASONS FOR STROKE::: worrying too much, high blood pressure, high diebetes/ sugar levels. CURE/ PREVENTION- diet, exercise. Eat fruits to LOWER blood pressure. For inflammation eat raw root turmeric haldi. Tea bags r giving headaches so can't be trusted. And eating too much sugar and sweetners give dark circles , loss of hair, memory loss. herpes can be caught smoking the hookah pipe. Hepatitis can be cured by drinking 1 glass of coconut water per day.- plz avoid drinking anything straight out of fridge- not good for heart I'm telling you. Lipoma LUMPS gone by fasting for at least 16hrs because fasting eats up cysts n tumours, lipoma lumps, eating omega 3, raw turmeric, drinking more water, exercising, massaging body BEFORE breakfast dinner . Plz AVOID cakes , muffins, doughnuts, fizzy drinks fried foods, soy sauce as they cause LUMPS. GET MOVING- you will notice that tingling sensation on LUMPS after exercising- proof. Also same feeling after drinking fizzy drinks- notice plz LACK OF WATER , CIRCULATION also cause of LUMPS in body. I spent a fortune on homeopathic tablets but to be honest doc put turmeric in those tablets. Surgery never is the cure knew a lady with so many lupms she got so many operations. Never the cure. To prevent strokes eat Apple banana n pears. To lower blood pressure immediately plz eat banana. Fruits can LOWER blood pressure and by drinking more water throughout the day. - plz avoid drinking n eating while standing n walking it's bad for the heart and joints. I eat on the floor/ carpet/ rug. Fibroids can be prevented by Avoiding chicken liver, tomato seeds, white flour so doughnuts cakes white sugars. Plz note too much lack of FERRITIN and IRON in body may cause heart attack so get eating beetroot, spinach carrots plz- avoid for few hours coffee milk, cake, doughnuts, cream, tea ,wholemeal bread, pitta as these STOP iron absorption so not your best friend

[@mahmoudelnaggar1268]

Brilliant! Thank you.

[@sherir6588]

Amazing video! This was so helpful when I took my SCRN (Stroke Certification) exam.

[@AlexM-su6dn]

Dirty, Coming on here post step and comlex to thank you for all these extra points. Between both exams I think I had a good 20-30questions related to this and I’m not joking. Bless you, your team, and everyone you love.

[@raihanmohammedmohiuddin9323]

amazingly done and beautifully created

[@meramahmoud8072]

Thank you sooo much!! The illustration was very informative and the questions were a very helpful application

[@acingmedicine]

The best video on brainstem lesions so far, tysm!

[@gogoblyn]

You make great videos too 😃

[@acingmedicine]

@@gogoblyn Wow Amrinder, thank you so much!

[@michellegiampaoli40]

I am a stroke survivors and mine was caused by stress and eating too much junk food from take away stores like McKay and other fast food outlets in my area. I suffered a stroke at home and my dad got in contact with the local Ambulance service to take me to the new Royal Adelaide Hospital to get treated immediately with medication and surgery to insert a stent into my right side of my brain via my wrist instead of my groin and then transferred to the Flinders Rehabilitation Centre at Bedford Park for the next few months to recover properly and start my Rehab the next day. I had the use of their equipment like the super big treadmill and robotic arm to which was attached to a computer game. It was fun at that time but it was hard work and it made me tired and had no energy to go on further. I was in the Tubrok Ward for the same amount of time. The staff including the doctors,nurses and physiotherapy team who got me up and moving again. After many months in Rehab sessions and I am back at home doing okay and 🚶‍♂️ every day even when it is cold and windy. I will still go out for my walk. If I don't do this my joints will seize up and I will not go for my usual walk for an hour or so.

[@Beastmd]

thank you for sharing your story. i hope you are doing better!

[@MarieArenbiCarillanes]

ang talino! ang galing! salamat sa tulong mo!!!

[@sabasaaleha5233]

Its 3:30 am and this video shows up on the top as i open youtube, and i now feel like crying cause you've made my entire neurology easy! 🥺 Thankyouu

[@dilandavis8901]

Options changed from Midbrain to pontine in the end. Though pontine was the correct answer anyway. Video was great by the way!

[@aditiwagh9470]

This is so good!👍👍 Thank you so much!!

[@cornelbacauanu1544]

Great explanation . Thank you.

[@novatusbwakea1704]

I also think it's important to remember the level of stroke, ie with cortical strokes we can say right or left stroke with more confidence than if stroke were to happen in internal capsule or other lower structures in the brain, nerve tracts pathways right!!!

[@thedoctorPB]

this was so damn good, it's fast, effective, and easy to remember. Thanks.

[@niloferkeshwani6207]

Thank You for simplifying 👍👍

[@NinjaKid3000]

Wish I had seen this earlier. Amazing video

[@istulover]

Genius ! Very nice video!

[@johnetntemgwa4344]

Woww. Excellent video. Thanks. You just made a difficult concept as easy as ABC. Thanks a lot.

[@MrTana48]

I am impressed with ur presentation

[@tm67245]

Thank you so much for this!!

[@susana426]

Amazing interpretation thanks a lot

[@doctortalks5031]

Love it . Saved my shelf exam

[@johnmagar7759]

Excellent.

[@vishalking7681]

May god bless u brother

[@ShanilR]

Internal carotid meets at base of skull branch into MCA & ACA (anterior communicating artery) Vertebral artery give rise basilar than to posterior cerebral (posterior communicating artery)

[@hallilafrankie272]

Thanks for this video. Helped me a lot more than BnB did for this topic.

[@khadifoxx]

This video is such a life saver. Can you please do a review of the cranial nerves.

[@someoneveryclever]

Thanks for the video!

[@darshanapatel-kalambi5726]

so awesome! Thank you so much.

[@chrischrist1378]

Nice presentation,well simplified approach,thanks a lot sir

[@drjasneetsingh]

Awesome video!!!

[@valentinaguzman1459]

Thanks!!! Now everything is easier

[@aa-yg4cj]

man, god bless you !!!!!!!!!!!!!!

[@smaarib]

THANK YOU SO MUCH FOR THIS.

[@padippistkallan884]

The best, smart teaching , i watch a lot of a topic to find wich video is best. but after comparing with others finally I find your videos as the best , if there is your video, there that will be the best out there

[@user-bq6xe6cb3l]

What a channel what a video 😍 You are amazing dear

[@factsworthkn0w]

So helpfull and soo simple approach to learn about stroke cases salute u sir thanks so much ❤

[@mbk928]

WOW, Straight THANK YOU

[@user-jx9hx1rn6e]

Man u r incredible thank u so much💛💛

[@kassemmagtary9299]

.Thank u so much, I understand this for the first time. How it was very was to know it perfectly .

[@hassanosman9719]

Thanks a lot, you make the dirty stuff a piece of cake.

[@yashranga4589]

thanks dude u r a life saver

[@doctorusmle1996]

Great work , Go On 😍

[@mathbykim1363]

Great video, we need more

[@MuhammadAli-ml9bt]

WOW GREAT YOU NAILED IT SIMPLIFIED SIMPLIFIED SIMPLIFIED

[@edwigemubonzi506]

Wow! Thank you thank you thank you!

[@meadhikari]

By the best. Simple and easy to understand..Thank you

[@SA-lr6tj]

Great video , thanks 👍🏽

[@ggthewhale]

Wow. Thank you so much!

[@amnazubair73]

Thank you. I never understood stroke like this before.

[@My_Secret_ArtSketchbook]

SIGNS OF STROKE::: left side neck arm pain, slurry speech, can't smile, face dropping to 1 side, difficult swallowing. REASONS FOR STROKE::: worrying too much, high blood pressure, high diebetes/ sugar levels. CURE/ PREVENTION- diet, exercise. Eat fruits to LOWER blood pressure. For inflammation eat raw root turmeric haldi. Tea bags r giving headaches so can't be trusted. And eating too much sugar and sweetners give dark circles , loss of hair, memory loss. herpes can be caught smoking the hookah pipe. Hepatitis can be cured by drinking 1 glass of coconut water per day.- plz avoid drinking anything straight out of fridge- not good for heart I'm telling you. Lipoma LUMPS gone by fasting for at least 16hrs because fasting eats up cysts n tumours, lipoma lumps, eating omega 3, raw turmeric, drinking more water, exercising, massaging body BEFORE breakfast dinner . Plz AVOID cakes , muffins, doughnuts, fizzy drinks fried foods, soy sauce as they cause LUMPS. GET MOVING- you will notice that tingling sensation on LUMPS after exercising- proof. Also same feeling after drinking fizzy drinks- notice plz LACK OF WATER , CIRCULATION also cause of LUMPS in body. I spent a fortune on homeopathic tablets but to be honest doc put turmeric in those tablets. Surgery never is the cure knew a lady with so many lupms she got so many operations. Never the cure. To prevent strokes eat Apple banana n pears. To lower blood pressure immediately plz eat banana. Fruits can LOWER blood pressure and by drinking more water throughout the day. - plz avoid drinking n eating while standing n walking it's bad for the heart and joints. I eat on the floor/ carpet/ rug. Fibroids can be prevented by Avoiding chicken liver, tomato seeds, white flour so doughnuts cakes white sugars. Plz note too much lack of FERRITIN and IRON in body may cause heart attack so get eating beetroot, spinach carrots plz- avoid for few hours coffee milk, cake, doughnuts, cream, tea ,wholemeal bread, pitta as these STOP iron absorption so not your best friend

[@andresfigueroaquast70]

Amazing - Greetings From Colombia - U re the best