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A case of vertigo

Posted Mar 15 2010 12:00am

History: A 48 y.o women complains of dizziness/vertigo for two days.  Symptoms worsen with activity including head movements and bending forward.  She also complains of sweatiness and feeling faint.  There is some ringing in the ears.  She has a history of CVA and loss of hearing.  Increased sinus drainage over the past two weeks.

She denies chest pain, shortness of breath, slurred speech, facial numbness, arm or leg weakness, difficulty swallowing.  No change in symptoms with moving supine to sit to stand.

Meds: calcium channel blocker (CCB), beta blocker (BB), angiotensin converting enzyme inhibitor (ACE inhibitor), clonidine

  • BP 180/100
  • Heart rate: 60
  • Cardiovascular and respiratory system exam: unremarkable.
  • Neurological exam: unremarkable
  • ENT exam: unremarkable
  • Rapid head movements: no vertigo
  • Dix Hallpike: neg
  • EKG: NSR at 60 bpm

Differential diagnosis:

  • acute vestibular neuronitis (peripheral)
  • benign paroxysmal positional vertigo (BPPV) (peripheral)
  • Meneire’s disease (peripheral)
  • postural hypotension
  • presyncope / vasovagal response
  • vascular compromise
  • subclavian steal
  • middle ear infection (peripheral)
  • acoustic neuroma (peripheral)

Working diagnosis:

Goals/plan for this patient:

Follow up in 1 week.  Sooner if needed.

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