00:00 - Intro
01:04 - Case presentation
02:17 - Anatomy of the vestibular system
08:07 - H.I.N.T.S. examination
16:26 - Pathological differential diagnosis
39:56 - Back to the case...
40:44 - Diagnostic testing
42:58 - Treatments
45:13 - Management algorithm
Narrated by:
Igor Rybinnik, MD
Produced by:
Igor Rybinnik MD
Neurology Clerkship Director
Rutgers Robert Wood Johnson Medical School
Special thanks to Dr. Peter Johns, University of Ottawa for his invaluable input and corrections.
Patient videos courtesy of:
- Dr. Peter Johns, University of Ottawa (https://www.youtube.com/user/peterjohns84)
- Newman-Toker DE, et al. H.I.N.T.S. to Diagnose Stroke in the Acute Vestibular Syndrome—Three-Step Bedside Oculomotor Exam More Sensitive than Early MRI DWI. Stroke. 2009 Nov; 40(11): 3504–3510.
Brain imaging cases courtesy of:
- A.Prof Frank Gaillard, Radiopaedia.org, rID: 10814
- Sand IK. Continuum 2016;22(3):864–896.
- Lee SU, et al. Cerebellum. 2019 Mar 2
Graphics, video clips adapted from:
- Cerebellum. Greg Dunn Design
- Netter FH. The Netter Collection of Medical Illustrations. 2nd ed. Saunders, 2013.
- Kandel ER, et al. Principles of Neural Science 5th Edition. McGraw Hill, 2012.
- Martin JH. Neuroanatomy Text and Atlas, 4th ed. McGraw Hill, 2012.
- Young Frankenstein. Dir Mel Books, Gruskoff/Venture Films, 1974.
- The Walk. Dri Robert Zemeckis, Sony Pictures Entertainment, 2015.
Disclaimer: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions expressed in this talk do not necessarily reflect those of Rutgers Robert Wood Johnson Medical school or Rutgers University as a whole.