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.

One key remedy from the East was opium, largely imported from Turkey. It had been in use in Egypt in the second millennium BC, and Avicenna إبن سينا called it 'the most powerful of stupefacients'. Ever the queen of drugs, it was profusely used in western medicine from the sixteenth century, and Thomas Sydenham (1624 - 89) later proclaimed that 'among the remedies which it has pleased the Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium.' It seemed the wonder drug; not just a pain-deadener, it also stopped dysentery and relieved respiratory disorders.

- The Greatest Benefit To Mankind

Stupefacient (n.)
A tranquilizer drug, causes drowsiness.

Poppy plant نبات الخشخاش

نبات الخشخاش هو اللي يستخلصون منه الأفيون Opium. الأفيون يحتوي على مركّب فعال هو المورفين Morphine اللي يشتغل على مستقبلات الأفيون اللي بجسمك ويتسبب بهواي تأثيرات من ضمنها تقليل الشعور بالألم، تقليل حركة الأمعاء، وشغلة أخيرة مهمة هي أنّه يشتغل على مراكز التنفس والكحة cough center بالدماغ ويمنع الكحة أو يقللها، بس بجرعات عالية ممكن يطفي مراكز التنفس أصلًا (بالإضافة للخدر وفقدان الوعي) فتتوقف عن التنفس وتموت بالإختناق.

Morphine is the active molecule.
While codeine is the prodrug of morphine (3-methylmorphine).

Dextromethorphan is from the same family but mainly works on the cough center, so you can find it everywhere in cough syrups.

Heroin is a derived compound of morphine thag was originally thought to be more potent (that's true) but less addictive (that's wrong) than morphine.

Morphine now is mainly used as a painkiller in cases of severe pain, and administered under strict supervision.
Codeine is used as a painkiller too, and rarely as a cough suppressant (it can be addictive).
Dextromethorphan is mainly a cough suppressant.
While Heroin, as far as I know, does not have medical uses.

الفكرة هي أنّ كلهن يسببن الخدر بدرجة أو بأُخرى، بس بنفس الوقت كلهن يأثرن على الـ cough center

لهذا مدمني هاي المواد يكونون تحت خطر الإختناق، لأن دماغهم يبطل يرسل الإشارة للرئة حتى تشتغل ويتنفسون.

House MD's vicodin is a hydrocodone¹/paracetamol

¹semi-synthetic opiate.