Lightheadedness

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of dizziness

Described as ‍lightheadednessfaintnesssensation of spinningfeeling unsteadyfeeling of floating

Pattern ‍persistentintermittent

Episodes last for ‍ ‍secminhours, and occurred ‍ times ‍overallper day

Worsening factors: ‍nonestanding up quicklyhead movementchange in positionon exertion

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍vertigo

‍unsteady gait

‍fall

‍loss of consciousness

‍tinnitus

‍hearing loss

‍visual disturbances

‍diplopia

‍dysphagia

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍sweating

‍palpitations

‍syncope

‍neck pain

‍confusion

‍anxiety



Contributing factors:

‍dehydration

‍alcohol use

‍exposure to stress

no history of: ‍PE risk factors, ‍arrhythmia, ‍valvular diseases, ‍benign paroxysmal positional vertigo, ‍anxiety disorders, ‍anemia

no use of: ‍antihypertensives, ‍diuretics, ‍anticonvulsants, ‍sedatives, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic:

- Mental status: ‍alert, oriented to ‍3 spheres, speech ‍intact

- Cranial nerves: ‍all intact

- Strength: ‍intact 5/5 throughout except for ‍4/5 on ‍rightleft ‍, ‍pronator drift

- Sensation: ‍intact throughoutdecreasedabsent to ‍light touch on ‍

- Reflexes: ‍intact 2+ throughout except for ‍1+ on ‍rightleft ‍, ‍plantar downward

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

- Gait: ‍steadyunsteady, ‍intactimpaired tandem gait, ‍intactimpaired heel walk and toe walk





ASSESSMENT:

‍Benign paroxysmal positional vertigo ‍likelysuspectedpossible

DDx: benign paroxysmal positional vertigo, vestibular neuritis, Meniere's disease, orthostatic hypotension, medication-induced dizziness, dehydration, gastrointestinal bleeding, cardiac arrhythmias, valvular diseases, myocardial infarction, PE, infections, anemia, hypoglycemia, anxiety/panic disorder, central nervous system disorders, cerebellar stroke, brain tumor, vestibular migraine, cervical spondylosis, visual disorders, ear infections, acoustic neuroma, age-related balance dysfunction, alcohol intoxication, peripheral neuropathy





PLAN:

Investigations:

- 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

Treatments:

- ‍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

Further care:

- 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