Peter Johns M.D.

Emergency Physician (retired from clinical practice) Vertigo enthusiast

[Peter Johns M.D. @PeterJohns84]

@KenV54 @angpeacock1111 HINTS distinguishes cerebellar stroke from vestibular neuritis. If other brainstem signs, it ain't vestibular neuritis!

[Peter Johns M.D. @PeterJohns84]

@KenV54 @angpeacock1111 Open evidence has epic fail also. "If nystagmus is direction-changing, purely vertical, or accompanied by other brainstem signs, the HINTS examination can help differentiate peripheral from central causes of acute vestibular syndrome.."

[Peter Johns M.D. @PeterJohns84]

@The_IMJ @TheRACP @WileyHealth Useless study. If you use HINTS to try to identify strokes in a retrospective study in all patients presenting with persistent vertigo, these are exactly the terrible results you will find. First screen for central features, then HINTS only if nystagmus present.

[Peter Johns M.D. @PeterJohns84]

@mindthebleep My youtube comments from 4 years ago still stand.

[Peter Johns M.D. @PeterJohns84]

@FredLepore Still remember being taught about that drug in overdose situation in the late 80's but never saw a case. Wild read about it in wikipedia. https://t.co/lAgDqHmuz8

[Peter Johns M.D. @PeterJohns84]

@vitaneuro Important things not clearly brought out in the paper: 1. Seeing clinical features that can occur in stroke but not expected to be seen in vestibular neuritis makes HINTS irrelevant. Work up for stroke. 2. Only perform HINTS when patient has nystagmus at rest.

[Peter Johns M.D. @PeterJohns84]

@drbeckycampb310 "This doesn't mean histamine is always the cause of vertigo". This is the understatement of the year with regards to vertigo.

[Peter Johns M.D. @PeterJohns84]

@i_ampriyanyk I'm glad you're on the mend. The fact that you had to have an MRI and a referral to an ENT before you got the right diagnosis and treatment is an epic fail for your neurologist. Even if you ask chat GPT it will tell you the most common cause of vertigo in MS patients is BPPV.

[Peter Johns M.D. @PeterJohns84]

@HeartOTXHeartMD @dr_annpersand It doesn’t sound like your emergency doctors ever achieved vertigo competence.

[Peter Johns M.D. @PeterJohns84]

@HeartOTXHeartMD @dr_annpersand What were the referrals that made you concerned about a posterior circulation stroke?

[Peter Johns M.D. @PeterJohns84]

@HeartOTXHeartMD @dr_annpersand I’m surprised at that.

[Peter Johns M.D. @PeterJohns84]

@HeartOTXHeartMD @dr_annpersand As a cardiologist, was this in the differential very often?

[Peter Johns M.D. @PeterJohns84]

@muksrockon Dizziness/vertigo is one of the few conditions that it's routine for doctors to make a joke about how little they know about it and how much they dislike it. It's trying to normalize the general state of ignorance about it. We need huge shift in our attitude about dizziness.

[Peter Johns M.D. @PeterJohns84]

@drterrynguyen There isn't one aspect of dizziness/vertigo that front line clinicians do well. But this is the one we should all know about. Decade of misinformation has made this difficult. Here is the way. https://t.co/qVEZiTvlmH

[Peter Johns M.D. @PeterJohns84]

@IrvanBubic A picture is worth a thousand words, a video is worth a thousand pictures. Watch my short video on the HINTS exam. https://t.co/kIv78aOPng

[Peter Johns M.D. @PeterJohns84]

@AdamMihara @SpikeEskin Nothing to do with a pinched nerve. It's crystals (otoconia) becoming displaced from utricle, ending up in one of the semi-circular canal, most commonly the posterior one.

[Peter Johns M.D. @PeterJohns84]

@ETtube Well, I did make this video over 10 years ago.... https://t.co/zKsnT7UVA4

[Peter Johns M.D. @PeterJohns84]

Check out my new video of how the nystagmus of vestibular neuritis changes with time, and one way you can avoid missing subtle nystagmus. https://t.co/qFXQOHPJ5M

[Peter Johns M.D. @PeterJohns84]

@nirmalregency 3PV, so it can be confused with 3PD? (vs BPPV and PPPV, also confusing). Why not think outside the box and call it ODD? (Otoconia Displacement Disease)? Shorter, easier to say the acronym and the long version. and describes the pathology.