Vertigo

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of vertigo

Described as ‍lightheadednessfaintnesssensation of spinningfeeling unsteadyfeeling of floating

Pattern ‍persistentintermittent

Episodes starts ‍graduallysuddenly, lasts 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

‍unsteady gait

‍fall

‍loss of consciousness

‍sweating

‍tinnitus

‍hearing loss

‍visual disturbances

‍diplopia

‍dysphagia

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍sweating

‍palpitations

‍syncope

‍neck pain

‍confusion

‍anxiety



Contributing factors:

‍stroke risk factors

‍recent head injury

no history of: ‍benign paroxysmal positional vertigo, ‍stroke or TIA, ‍migraine

no use of: ‍antihypertensives, ‍sedatives, ‍new medication



Occupation: ‍ ‍lowhigh risk of injury for self or others

Driving license: ‍yesno





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, ‍

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, labyrinthitis, vestibular migraine, acoustic neuroma, central vertigo, stroke, cerebellar hemorrhage, cerebellar stroke, head trauma, anxiety, epilepsy, cholesteatoma, neurological disorders, cardiovascular issues





PLAN:

Investigations:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍glucose, ‍TSH

- ECG

- Audiogram

- Vestibular tests

- CT scan of the brain

- MRI of the brain

Treatments:

- ‍Antihistamines

- ‍Antiemetics

- Stop medications that may contribute to vertigo (antihypertensives, sedatives)

- Vestibular Rehabilitation Therapy

- Dietary modifications: ‍limit alcohol, ‍limit caffeine, ‍limit salt

Further care:

- Referral to otolaryngologist

- Referral to neurologist

- Follow-up in ‍ ‍daysweeks

- Return if vertigo worsens, if new symptoms develop such as hearing loss, tinnitus, or severe headache