Dizziness

HISTORY:

Dizziness for ‍ ‍hoursdays

Type: ‍lightheadednessfaintnesssensation of spinningfeeling unsteadyfeeling of floating

Pattern: ‍constantintermittent

Episode duration: ‍ ‍secminhours, and occurred ‍ times ‍overallper day

Worsening factors: ‍nonestanding up quicklyhead movementchange in positionon exertion

Alleviating factors: ‍none, ‍effectiveineffective

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍vertigo

‍unsteady gait

‍fall

‍loss of consciousness

‍tinnitus

‍hearing loss

‍visual disturbances

‍diplopia

‍dysphagia

‍headache

‍sweating

‍palpitations

‍syncope

‍neck pain

‍confusion

‍anxiety



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Ears: -R: ‍normal, -L: ‍normal

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Neurologic:

- Mental status: ‍alert, oriented in ‍3 spheres, speech ‍clear

- Cranial nerves: ‍all normal

- Strength: upper extremities -R ‍543210/5 ‍, -L ‍543210/5 ‍

lower extremities -R ‍543210/5 ‍, -L ‍543210/5 ‍

- Sensation: upper extremities -R ‍normal, -L ‍normal, ‍fine touch

lower extremities -R ‍normal, -L ‍normal

- Reflexes: triceps -R ‍4+ (clonus)3+2+1+0+, -L ‍4+ (clonus)3+2+1+0+, biceps -R ‍4+ (clonus)3+2+1+0+, -L ‍4+ (clonus)3+2+1+0+, brachioradialis -R ‍4+ (clonus)3+2+1+0+, -L ‍4+ (clonus)3+2+1+0+

patellar -R ‍4+ (clonus)3+2+1+0+, -L ‍4+ (clonus)3+2+1+0+, achilles -R ‍4+ (clonus)3+2+1+0+, -L ‍4+ (clonus)3+2+1+0+, plantar -R ‍flexionextension, -L ‍flexionextension

- Cerebellar function: ‍normal, finger-nose ‍normalimpaired, rapid alternating movements ‍normalimpaired, heel-knee ‍normalimpaired, Romberg ‍negative, Dix-Hallpike ‍negative, ‍

- Gait: ‍steadyunsteady, tandem walking ‍normalimpaired, heel and toe walking ‍normalimpaired



ASSESSMENT:

‍Benign paroxysmal positional vertigo ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍glucose, ‍TSH, ‍d-dimers, ‍β-HCG

- ECG

- Blood pressure monitoring

- Holter monitor

- Echocardiogram

- CT scan of the brain

- MRI of the brain

- Audiogram

- Vestibular tests

- ‍Antivertigo medications

- ‍Antiemetics

- Dicontinue medications that may cause dizziness (antihypertensives, diuretics, anticonvulsants, sedatives)

- Vestibular rehabilitation therapy

- Lifestyle modifications: ‍avoid sudden movements, ‍avoid triggers such as caffeine and alcohol, ‍adequate hydration, ‍adequate sleep, ‍stress management

- Referral to cardiologist

- Referral to neurologist

- Referral to otolaryngologist

- Follow-up in ‍ ‍daysweeks

- Return if dizziness persists, if new symptoms develop such as hearing loss, fainting, or neurological symptoms