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Re: "Dizzy" case presentation 2

 
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Re: "Dizzy" case presentation 2 - July 7, 2006 6:59:00 AM   
CMVPT

 

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Has she been on any vacations or events where she was at sea or in the air for an extended time?

gaze holding nystagmus? Resting nystagmus?

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Re: "Dizzy" case presentation 2 - July 7, 2006 8:16:00 AM   
FLAOrthoPT

 

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oh oh oh to touch and feel....I got it 3 and 6 you said...oh and and...easy now!
Ben

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Re: "Dizzy" case presentation 2 - July 7, 2006 8:17:00 AM   
Sebastian Asselbergs

 

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Suspect a malignancy retro-orbicular? At the level of vestibular nerve? Not knowing what the dizziness is all about - does it occur when patient changes position and then settle?

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Re: "Dizzy" case presentation 2 - July 7, 2006 8:31:00 AM   
USAPT

 

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Previous head injuries?

What were the results of the CAT scan? Brain stem damage can cause these symptoms.

Ptosis?

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Re: "Dizzy" case presentation 2 - July 7, 2006 8:40:00 AM   
Sean_Collins

 

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Oh wait - she is dizzy - is she also blonde?

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Re: "Dizzy" case presentation 2 - July 7, 2006 9:56:00 AM   
USAPT

 

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just to clarify, I realize CNs are part of pontine system. :)

any weakness in arms or legs?

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Re: "Dizzy" case presentation 2 - July 7, 2006 10:02:00 AM   
Sebastian Asselbergs

 

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In addition to suspecting a possible malignancy, because of the intermittent symptoms (dizziness, headaches) a fluctuating pressure could be at work - i.e. an aneurysm.

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Re: "Dizzy" case presentation 2 - July 8, 2006 9:07:00 AM   
jma

 

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Has the patient been seen by an opthalmologist recently? Does her pupils respond to different light intensities? Are there any eye pressure issues on the retina or optic nerve?

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Re: "Dizzy" case presentation 2 - July 10, 2006 2:15:00 AM   
cej7

 

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Here is my list of 'off the cuff' ddx ideas based on above info & without researching:

Primary suspects:
1.Neurovascular
-Central (CN involvement, Hx HA (atypical migraine, birth ctrl use)
2.Metabolic
-Thyroid
3.Autoimmune
-NMJ dz ie. myesthenia gravis due to CNs involved; prior episode
-MS

Possible, not probable:
4.CV
-arrhythmia(effort/aerobic demand, birth ctrl use)

Less likely:
5.Neoplasm
6.Psychogenic

Naturally, I would not be making these dx's, but if and when appropriate, I can rule in/out the BPV component, and send the pt. in the right direction with a bit more info. Furthermore, I think this is appropriate to start thinking this way (in terms of ddx) so pertinent information isn't overlooked.

~ Liz ?!

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Re: "Dizzy" case presentation 2 - July 10, 2006 12:51:00 PM   
Dr.Wagner


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She tells you that the previous CT was "normal".

She also denies any head trauma, accidents etc.

You inquire to the reason for the previous CT she states..."Yeah, I forgot, but I had blindness in that eye for a day, it my eye hurt really bad too, I remember that it sucked because it was in the middle of summer...it just went away. They did an spinal tap on me for some reason, it was normal too"

The patient does have a nystagmus, but it is difficult to test primarily because of the cranial nerve problem. she states "I am really tired now"


What does she have?

What is the diagnostic test of choice?

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Post #: 30
Re: "Dizzy" case presentation 2 - July 10, 2006 6:03:00 PM   
KAK

 

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MS
MRI of the brain

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Post #: 31
Re: "Dizzy" case presentation 2 - July 10, 2006 11:56:00 PM   
cej7

 

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I concur.

dx: MS

dx test of choice:
gadolinium enhanced MRI of head

~liz

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Post #: 32
Re: "Dizzy" case presentation 2 - July 11, 2006 9:38:00 AM   
Dr.Wagner


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This is a classic presentation of MS.

This patient presented to me in the ER 2years ago, exactly as I presented.

In her case, I had ordered a CT in the ER, the CT showed lesions consistent with MS. She was admitted for a MRI the next day.

It was a good case and still an interesting conclusion to a complaint of "dizzy"

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Post #: 33
Re: "Dizzy" case presentation 2 - July 27, 2006 12:13:00 AM   
jbird007

 

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Dr Wagner,

Do you check cranial nerves as per the book? (2 point discrimination, a complete trigeminal evaluation, uvula deviation, olfactory test, snellen, gag reflex, etc.) Or do you just do a "quicky" version? TY

Jbird

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Post #: 34
Re: "Dizzy" case presentation 2 - July 27, 2006 8:58:00 AM   
Dr.Wagner


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I do a "quick" exam usually a letting the clinical presentation to be my guide (I watch them talk and interact with me). To be honest, most times it is pointless to become too involved with cranial nerve testing...it usually yeilds very little additional information unless you suspect a lesion involving cranial nerves.
Does that make sense?

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Post #: 35
Re: "Dizzy" case presentation 2 - July 27, 2006 9:35:00 AM   
USAPT

 

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Doc,
any new cases??...not that you're busy or anything:)

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