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Most of us were taught and continue to be taught that sustained apogeotropic nystagmus indicates cupulolithiasis when the lateral canal is involved.

But what if that’s not necessarily true?

In this blog I want to take you on a brief journey and challenge what we’ve traditionally been taught about these presentations. 

Understanding Horizontal Canal BPPV

I think that we can all agree that when positional testing (i.e. Supine Roll, Dix-Hallpike, Sidelying, Bow & Lean) produces horizontal nystagmus, we are most often dealing with horizontal canal BPPV. It’s important to remember that positional nystagmus can also be seen with conditions such as light cupula or central causes.

The classic p...

Interest in creatine for concussion recovery continues to grow among clinicians, athletes, and patients looking for strategies to support brain healing. As providers managing concussion, prevention remains foundational. When injury occurs, however, the focus shifts to a key question:

What physiologic environment best supports neurologic recovery?

Evidence-based concussion management emphasizes education, graded return to activity, sleep optimization, autonomic regulation, and targeted rehabilitation. Increasingly, patients also ask about supplements. As a result, clinicians need clarity on whether creatine for concussion recovery is biologically plausible, clinically useful, or still theor...