Jordan Smedresman SUNY Downstate College of Medicine Class of 2013.
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Transcript of Jordan Smedresman SUNY Downstate College of Medicine Class of 2013.
DIZZINESS IN THE EDJordan Smedresman
SUNY Downstate College of Medicine Class of 2013
30 year old woman with “dizziness”
Suddenly started ~6 hours prior to evaluation when she stood up after dinner
Felt the room spinning, had to be supported to keep from falling
Nausea , one episode of vomiting Similar episode one week prior,
spontaneously resolved after “a few hours” No history of trauma, no recent illness, no
tinnitus Still unsteady on her feet, but gradually
improving, nausea has resolved
PMH—anemia PSH—c-section 7 years ago Allergies—shellfish (rash), no drugs Meds—iron, Centrum
Temp 98.2, HR 86, RR 16, 178/107 (repeat 150/100)
Physical exam unremarkable
Neuro Exam
Alert and oriented x3 CN II-XII intact, slight horizontal nystagmus
upon turning the head, worse when turning left
Muscle strength 5/5 in all extremities, normal sensation
Reflexes 2+ throughout FTN intact Gait unsteady, not ataxic Upon lying flat, symptoms returned Patient refused Dix-Hallpike test
Labs
WBC: 9.3 Hb: 12.4 Hct: 40.6 Plt: 344 MCV: 65 β-HCG: 0 T4: 1.18 TSH: 1.792
Na: 141 K: 4.2 Cl: 104 CO2: 26.6 BUN: 14 Cr: 0.6 Glucose: 104 Ca: 10.2
Benign Paroxysmal Positional Vertigo
Usually multiple short (seconds) episodes reproduced by tilting the head
Often caused by canaliths Can last weeks to months Vomiting is rare Diagnosed through history. Dix-Hallpike
can helpful (50-80% sensitive)
Canalith Repositioning
Vestibular Neuronitis
Believed to be viral or postviral inflammatory disorder
Rapid onset of severe, persistent vertigo with nausea/vomiting and gait instability (fall toward affected side)
Spontaneous nystagmus Clinical diagnosis Usually lasts 1-2 days
This patient
Time course—vestibular neuronitis Suggestive setting—BPPV (more
predictable head movements, no recent illness)
Nystagmus—more typical of vestibular neuronitis
Treatment—meclizine with ENT followup Second line—benzos