Vertigo Case Paper

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Chief Complaint

Patient is a 58-year-old right-hand white male interviewed in the presence of his wife. He was previously seen by me last month for admission for the acute onset of vertigo with possible TIA or stroke as etiology. He stated that he awoke on 06/18/2015 in his usual state of health and then went to work and while there, he had the sudden onset of marked spinning vertigo. He was unable to walk straight, but denied any bilateral lower extremity weakness. He did have nausea and vomited several times. He initially denied any diplopia, visual field cut, blurred vision, facial asymmetry, facial or body sensory changes, dysarthria, or focal weakness. He continued to have marked vertigo in the emergency room, …show more content…

He also had right more than left mastoid opacifications and states that he was recently treated for otitis media. He has hypertension, hyperlipidemia, coronary disease and had been noncompliant with his medications in the past. His exam was essentially normal except for the subjective vertigo. There was no nystagmus and no diplopia on the initial exam. On 06/19/2015, he gave a different history. He states that he had a strike to the left temporal on Tuesday 06/16/2015. This did not result in any vertigo or any other neurological symptoms at that time. It was two days later that he had the vertigo at work. The patient also claimed that he had been seeing double since the previous night and the morning of the 19th. However, his neurological exam at that time, failed to reveal any actual disconjugate gaze. The patient had an MRI MRA, which revealed old white matter ischemic disease and mild intracranial atherosclerosis, but no evidence for acute stroke or posterior circulation significant stenosis. His diagnosis was labyrinthitis, possibly due to his bilateral mastoiditis. He was treated with Augmentin for 10 days. His symptoms resolved prior to discharge on meclizine. On physical therapy on discharge, he had no

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