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Gentamicin to poison the ear and treat Meniere's disease

It's a special type of migraine, basically. You'll find it in patients with a history of migraine.

If a patient comes in with a vertigo that lasts for hours, and he has a hx of migraine, then you should think of this.

Criteria for diagnosis:

• Episodic, spontaneous vertigo that lasts for hours.
• 2 or more migraine symptoms ( migrainous headache, photophobia, phonophobia, visual aura or other type of aura), occuring during at least 2 episodes of vertigo.

Successful triptan treatment is generally diagnostic, since triptan is used for migraine.

Headache may occur during or following vertigo (in this case, the vertigo is considered a migrainous aura).

Spontaneous vertigo that lasts for days, regardless of the cause.

من يجيك المريض، يكلك أنّ الدوار مالته صارله أيام مستمر وما متوقف أصلًا (حركة الراس ممكن تزيده، بس مو هي السبب، يعني spontaneous vertigo).

أهم خطوة نسويها وية هيج مرضى، هي أنّ نتأكد هل السبب central أو peripheral، لأن السبب الأول خطير وممكن يكون بسبب جلطة بجذع الدماغ أو مرض عصبي أو غيره، بينما الثاني بسيط نسبيًا ومو بنفس خطورة الأول.

The HINTS exam has a sensitivity of almost 100% and specificity of 96% for stroke. Therefore it is superior to imaging studies like MRA which are more costly and time-consuming.

As many as 25% of patients older than 50 years presenting to the emergency department with this clinical picture have a cerebellar infarction rather than vestibular neuritis. As this alternative diagnosis represents a potentially immediately life-threatening condition, it is important to consider this possibility in every patient who presents with acute sustained vertigo.

Patients with a vascular event (stroke) are typically older and/or have atherosclerosis risk factors (hypertension, diabetes, smoking).
Despite these caveats, the distinction between vestibular neuritis and acute cerebellar lesions is not always apparent; patients with acute vertigo are often quite ill, and the examination may be limited. When the diagnosis is unclear, a neuroimaging study, typically MRI, may be necessary

Brainstem infarction — The most common stroke syndrome causing vertigo produces a constellation of symptoms and signs known as a Wallenberg syndrome:

• Ipsilateral Horner syndrome
• Dissociated sensory loss (loss of pain and temperature sensation on the ipsilateral face and contralateral limbs and trunk)
• Abnormal eye movements
• Ipsilateral loss of corneal reflex
• Hoarseness and dysphagia
• Ipsilateral limb ataxia

While these signs are usually apparent after a careful neurologic examination, these signs may be overlooked by patients and non-neurologists because the vertigo, nausea, and vomiting may overwhelm the clinical picture. 

Usually patients suffer from vestibular neuritis only once. The clinical picture is that they generally suffer from severe vestibular symptoms for one to two days, followed by a gradual diminution of symptoms and a return of equilibrium. While the acute illness rarely lasts more than several days to a few weeks, residual imbalance and nonspecific dizziness may persist for months. Early improvement in symptoms is believed to be largely due to central compensation.

Potential treatments for vestibular neuritis include acute disease-specific treatment with glucocorticoids and antiviral agents, symptomatic treatments, and vestibular rehabilitation. 

Milder variants of somatization disorder are more common than the full-blown entity. Such variants may be precipitated by stress or minor physiologic disturbances. Paradoxically, such patients are often disturbed by negative test results rather than reassured.

مريض الـ somatization من تكله «ما بيك شي» رح يتوتر أكثر مما لو تكله «بيك فلان مرض.»

هالشي لأن بنظره، هو ديعاني من مشاكل جسدية بحتة، مو نفسية، ولهذا هو يبحث عن "تفسير" لهاي المشاكل الجسدية. انت لما تكله «ما بيك شي» أو «التحليل مالتك طبيعي» معناها ما انطيته أي تفسير وبعده هو بحالة الضياع اللي ديعاني منها.

The story of Syphilis:

Columbus may have brought one killer disease back from the Americas: syphilis. This broke out in 1493-4 during a war between Spain and France being waged in Italy. When Naples fell to the French, the conquerors indulged in the usual orgy of rape and pillage, and the troops and their camp-followers then scattered throughout Europe. Soon, a terrible venereal epidemic was raging.
It began with genital sores, progressing to a general rash, to ulceration, and to revolting abscesses eating into bones and destroying the nose, lips and genitals, and often proving fatal.
Initially, it was called the 'disease of Naples', but rapidly became the 'French Pox' and other terms accusing this or that nation:
the Spanish disease in Holland, the Polish disease in Russia, the Russian disease in Siberia, the Christian disease in Turkey and the Portuguese disease in India and Japan. For their part, the Portuguese called it the Castilian disease, and a couple of centuries later Captain Cook (1728-79), exploring the Pacific, said that the Tahitians 'call the venereal disease Apano Britannia - the British disease' (he thought they'd caught it from the French).

- The Greatest Benefit To Mankind

يكلك هلكد ما السفلس جان خطير ومخوّف الناس بأيام قبل، جانوا يجربون وياه علاجات خطيرة تكاد تكون بنفس سوء المرض.
مثلًا جانوا ينطون للمرضى زئبق (ويسببون الهم تسمم مزمن بالزئبق) حتى يقتلون بكتيريا السفلس ويعالجوه.
أو ببداية القرن الـ 20 جانوا يعالجون السفلس عن طريق إصابة المرضى عمدًا بالملاريا لأنها تسببلهم حمى عالية بما فيه الكفاية لطبخ بكتيريا السفلس بداخل جسم المريض وبالنتيجة علاجه.

جزء جبير من الرعب اللي يسببه السفلس هو أنّه حرفيًا "ياكل" اللحم والغضاريف والعظام. يعني هواي مرضى تشوف عدهم قروح تمتد من الجلد وصولًا للعظم، كأنما أكو أحد حافرها عمدًا.