Vertigo myth: Central vs peripheral tables help you make the diagnosis in vertigo

Tables consisting of the characteristics of undifferentiated vertigo divided into central and peripheral causes are NOT helpful clinically and should not be used.
The Big 3 of Vertigo algorithm is a much better approach for vertigo novices to learn.
"Clinical diagnosis of BPPV and vestibular neuritis" by Johns and Quinn www.cmaj.ca/content/192/8/E182
"Does my dizzy patient have a stroke?" by Tarnutzer et al
www.cmaj.ca/content/183/9/E571
00:00 Intro
01:46 Short answer
02:33 Personal background story
03:35 Typical tables
03:56 How they were supposed to work
04:27 Why they don't work
06:40 Rosen's table from 1983
11:06 Rosen's table from 2018
14:17 Table from youtube lecture
15:00 Final verdict
15:34 The Big 3 of Vertigo approach
16:28 Conclusion and outro

[@mariaosip5376]

Waw!!! Thanks from Belerus!!! it's very useful information for my practice. Your channel is the best on KZbin in vertigo topics.😄

[@zuneid375]

Hi Dr. Johns, Thank you for this helpful tip, I will spread your video across my community. Best regard from Mozambique.

[@tonyf315]

These videos are more important than ever for the vestibular physical therapy group I facilitate, as with the pandemic, "in person" learning is getting harder to provide but video learning is an ever-available lifeline-many thanks!

[@amandakiernan3374]

Cant understand this speaker...talks way too fast I'm even more confused! And I've 2 degrees.

[@louiselmf6671]

Thanks for your research and getting info out to doctors. I'm 7 yrs disabled after a VAD (chiropractor) and cerebellar stroke. ER treated me for nausea and sent me home. Acute onset vomiting, EXTREME PAIN in eyes and ears and unable to remain upright. CT scan 24 hours after symptoms and MRI 24 hours after that!!😡 2+ years for dx after being told "you'll be fine in a few weeks". Finally dx with bilateral vestibular dysfunction, poor VOR, abnormal saccades and eye convergence, teaming, tracking problems. Caloric testing , posturography and neuro optometric testing were most helpful while ER dr, hospitalist, neurologists and standard optometry were USELESS!! Now, adapting and not stressing about getting better...not gonna happen.

[@aolli2359]

Thanks for making such an enlightening video. I agree that this division into peripheral and central causes of vertigo mainly serves to confuse everyone.

[@brunomontagna4801]

Awesome. Greetings from Brazilian Medical student.

[@johnkuo855]

🌹🌹🌹Thanks for making such an enlightening video.🌹🌹🌹

[@sallas5534]

I hope i can help any medical students when i finish my specialist I am thanking you alot doctor

[@hanktsung-hanlee1188]

Dr. Johns thanks for making the topic of vertigo SO CLEAR! For years I felt I didn't have a good grasp to the approach of undifferentiated vertigo. It was only luck that serious causes are rare and I haven't had an adverse outcome. I've watched every video of yours and found them to be so helpful! Recently I was able to diagnose a migraine vertigo with confidence and successfully treat it. I like to use chlorpromazine + N saline for that, as I found metoclopramide not as helpful. What do you think about chlorpromazine? Thank you again for your teaching and always looking forward to another video. Wish you (and Epley) well! (A New Zealand ED resident)

[@PeterJohns]

I haven't used it in 30 years, but it did work back then. You get more hypotension with it compared to metoclopramide though..

[@augiecig2749]

perfect. After 10 years of practicing and not having a real approach to these patients, we are finally on to something big here. Ill spread the gospel to my group

[@ericandrius]

What a amazing vídeo!!!!

[@EduardoMaiaMP]

Thanks! I'm a Brazilian 1st-year medical student and I've been struggling with those tables for a couple weeks since I noticed that the differences weren't so clear depending on the case. This is really helpful and I'll recommend that to all my friends here in Brazil.

[@pinkpanther275]

Excellent job as usual! Greetings from Ukrainian fan🖐️

[@jeekid]

Great video! Textbooks should change thier central vs peripheral dichotomy to Dr. John's big three. Let's teach big three to our residents; let's change emergency physician's practice.

[@PeterJohns]

Tintinalli's emergency medicine textbook latest edition was written by myself and Brian Goldman. Thanks for your support Jason!

[@louiselmf6671]

I'm a VAD and cerebelar stroke patient. My treatment and DX were terribly poor. I am available to any provider, student or researcher who has questions or if I may be of any research help.

[@Anthony-ge2ux]

Audiologist here. Thank you for the helpful information

[@louiselmf6671]

I'm a VAD and cerebelar stroke patient. My treatment and DX were terribly poor. I am available to any provider, student or researcher who has questions or if I may be of any research help. Louise.funny gee mail

[@drjws1]

Thank you for this. My experience is essentially identical to yours.

[@PeterJohns]

Interesting! Are you a doctor?

[@drjws1]

@@PeterJohns Yes a neurologist

[@PeterJohns]

@@drjws1 Glad you were able to find the light! Many neurologists and ENT and emergency MD's and family MD still have not.

[@drjws1]

@@PeterJohns I agree many robotically follow the tables you correctly criticize. I started to look into this much more carefully years ago after reading an early report of a patient with a cerebellar stoke with nystagmus mimicking “peripheral nystagmus”.

[@whonix4317]

I’ve seen many cerebellum strokes sent home. I expect your approach would improve that rate.

[@harishchandergoel5159]

Nice👍