Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Dizziness: A case based discussion Wesam El-MahmoudiPresenting Complaint 73 y/o male presenting with 3/7 hx of dizziness and headacheHPC  Mr.X noticed dizziness 3/7 ago at first after trying to get up from the sofa after sitting there for hours.  The dizziness is an “unsteady and unbalanced feeling” and has been present most of the day. The intensity of this feeling is variable throughout the day.  Patient mentions that this feeling makes him feel nauseated. But no vomiting  Headache came later on the first day. It is moderate, throbbing in nature and wraps bilaterally around the forehead. HPC  Dizziness is exacerbated by sudden movements of head.  Denies feeling faint, spinning sensation, ear pain, tinnitus, fever  No vomiting, facial drooping, numbness, weakness vision changes or weight loss.  No previous episodes of dizziness like this before.  Has been taking paracetamol and ibuprofen OTC  Patient has pre-existing hearing difficulties and is already totally deaf in his left ear. He uses a hearing aid in the right ear.PMH  Hypertension  T2DMDH / FH  Metformin 850mg OD  Amlodipine 7.5mg OD  Atorvastatin 20mg ON  Omeprazole 10mg OD  NKDA  No relevant family historySH  Ex-Smoker. Smoked 10 a day for 35+ years. Quit 10 years ago  Drinks 4-5 units a week  Lives in a bungalow with his wife. Usually independently mobile and able to complete ADLs Examination  Patient is very unsteady on feet, grabbing wall for balance.  Patient at rest end of the bed  HR: 88 BP: 141/82 RR: 12 SpO2: 98% T: 37.2  On inspection of the ear no discharge, no inflammation, tympanic membrane intact and ossicles seen  All cranial nerves were intact. Hearing could not be formally assessed due to existing impairment.  Upper and Lower limbs had no abnormality in Tone, Power, Coordination and Reflexes  Patient oriented in time place and person. No slurred speech  Romberg’s test showed loss of balance DDx  Vestibular Neuritis / Labyrinthitis  Cerebrovascular Event – e.g. Brainstem infarction or Cerebellar haemorrhage or infarction  BPPV  Meniere’s  Other non – rotary causes – postural hypotension , vasovagal episodes, migraine, anxiety, drugs, alcoholInvestigations  FBC, U/E  Weber and Rinne test for hearing  Audiogram  CT / MRI if high risk or symptoms of CVA  Hallpike manoeuvre for BPPV V estibular neuritis / Labyrinthitis  A benign self-limited disorder which can mimic CVA. After BPPV it is the second most common cause of vertigo  Most patients have a 3-5 day acute phase and then slowly recover over 3 weeks  Symptoms include vertigo, nausea, vomiting, and gait impairment  Usually a viral or post viral inflammatory disorder affecting the vestibular portion of the eighth cranial nerveOtitis media, meningitis, syphilis, HIV and other infections are a risk factor for this infection. Otitis and meningitis tend to present as more severe bacterial infections In pure vestibular neuritis, auditory function is preserved; when this syndrome is combined with unilateral hearing loss, it is called labyrinthitis. Management  Vestibular suppressants: i.e antihistamines with anticholinergic properties (e.g., promethazine, cyclizine, dimenhydrinate) **  Anti-emetics: (e.g., prochlorperazine, metoclopramide, ondansetron)  Glucocorticoids: (e.g. prednisolone)  Vestibular rehabilitation: Physiotherapy to help reduce symptomsWeber, Rinne and HallpikeThank you for listening Questions?OSCE TIPS