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The patient had experienced the dizziness for the past 1 month, it is episodic,
and lasted for less than one minute on each attack. He described the dizziness
as spinning, which is exacerbated mostly by head movement, and sometimes
when looking at moving objects and hearing a loud sound (e.g watching
gymnastic or aerobic session). He often felt nauseous but still able to hold
himself from vomiting.
The complaints went severe for the past two days, the dizziness came more
often and lasted longer than before. He couldnt walk on his own, nor
balancing his body while standing. He felt very nauseous and vomited 5x /
day.
HISTORY OF PRESENT ILLNESS
Since then, he became weak and refused to eat. Lying still in bed
without moving helped to alleviate his symptoms.
He denied having complaints such as tinnitus, hearing loss, double
vision, visual field defect, dysarthria, paresthesia, or other
neurologic symptoms favors central vestibular abnormalities.
MEDICAL HISTORY
Normocephal
Head Symmetrical
Cyanosis (-)
Mout
h Dryness (-)
Lymph nodes & thyroid gland not palpable
Neck Neck stiffness (-)
GENERAL EXAMINATION
Mening
eal Neck stiffness (-) Speech
signs Brudzinsky I (-)
Motoric aphasia (-)
Sensory aphasia
Brudzinsky II (-)
(-)
Kernig (-)
Dysarthria (-)
Laseque (-)
CRANIAL NERVES EXAMINATION
Not performed
N. II (Optic nerve)
Not performed
Strabismus (-)
Nystagmus (-)
Exophtalmos (-)
Pupils : 3 mm / 3 mm; isochoric
Direct light reflex +/+
Indirect light reflex +/+
CRANIAL NERVES EXAMINATION
N. IV (Throchlear nerve)
N. V (Trigeminal nerve)
N. VI (Abducens nerve)
N. IX (Glossopharyngeal nerve)
N. X (Vagus nerve)
N. XI (Accessory nerve)
Motoric Pathologic
Strength : 5555/5555 Babinsky - /-
Trophy : Normal Chaddock - / -
Tone : Normal Schaeffer - / -
NEUROLOGICAL EXAMINATION
Nystagmus : (-)
Sharpened Romberg test: swaying (+) conducted when the
patients dizziness has gone
Heel to knee test : tremor (+) when conducted by left foot
Past pointing test : normal
Disdiadochokinesia : normal
Dix-Hall pike test : not performed
SUMMARY
Diagnosis
X1 K: Peripheral vestibular vertigo
E : Idiopathic
T : Peripheral vestibular system
P : Displaced otolith
X2 hyponatremia, hypokalemia
TREATMENT
Non pharmacological:
Brandt-Darroff exercises
Pharmalogical
IVFD RL /12 hours
Ranitidine 2 x 50mg (1 amp) i.v
Ondancentrone 3 x 8 mg (1 amp)
Betahistine 2 x 24mg
Flunarizine 1 x 10mg
THANK YOU