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Bubbles, Bubbles Everywhere!
  1. John Bamford
  1. St James’s University Hospital, Leeds, UK; Email: j.m.bamford{at}


Back in 1993 it had been a fairly average afternoon in the neurovascular clinic; a couple of obese, hypertensive smokers with clear-cut transient ischaemic attacks whose seemingly programmed lack of motivation to modify their vascular risk factors would subsequently challenge all the persuasive skills of my Specialist Nurse. Well at least I could guarantee a carotid bruit for the medical students to listen to. Mixed in were the migraines without headache, or at least that is what I called them, and the paroxysmal positional vertigo that had been labelled as ‘vertebrobasilar insufficiency’, a term that in my view should either be used as it was first intended or discarded altogether but certainly not as an exit strategy from general practitioner surgeries or Ear, Nose and Throat clinics! On top of this a colleague’s mother had been put in as an extra after an episode of amnesia and so, almost inevitably

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