Case discussion 2015/07/21 PGY 何御彰. Chief complaint Dizziness with mild nausea and vomiting for two days.

Slides:

Advertisements

Similar presentations

Stroke Workshop Case Scenario.

Advertisements

Clinical Manifestations Progressive headache – No history of infection – Lack of fever, GI and urinary problems – Unremarkable laboratory work-up – Increasing.

Head and Neck, Eyes, Ears, Nose, & Throat

Dizziness and Vertigo Shawn Stepp, PA-C Central Maine Medical Center Emergency Department We have all had the vague Dizzy patient in the office or the.

Practical Management of MS in the Primary Care Office Setting Case Study 2.

Osteology and Articulations of the Back 2008 Gray’s Pages

Jordan Smedresman SUNY Downstate College of Medicine Class of 2013.

Balance Function Testing

Dizziness, Disequilibrium and Vertigo  There are three symptoms that are often refered to as dizziness by patients: dizziness, disequilibrium and vertigo.

Acute Stroke - the role of EMS Diane Handler, RN, MSN, MeD, ANVP Stroke Coordinator Mercy Medical Center, Cedar Rapids. Iowa

A practical approach to dizziness

Sarah Hodges, DO Staff Neurologist

University of Michigan

Meniere's Disease Leona Šupljika Gabelica Mentor: A. Žmegač Horvat.

Inpatient Evaluation of The “Dizzy” Patient

Transient Ischaemic Attack Nin Bajaj Consultant Neurologist QMC & DRI.

An Approach to the Patient with Vertigo Cynthia Phelan PGY

“Doctor I feel Dizzy” AIMGP Seminar 2004 Yash Patel.

Head of Otology / Neurotology Unit

Anatomy of the ear.

NYU Medical Grand Rounds Clinical Vignette

Functioning Organs of Vision

Head and Face. Anatomy  Eyes  Ears  Nose  Jaw  Mouth  Brain.

Posterior Stroke and the H.I.N.T.S exam LMH Emergency Rounds Prepared by Shane Barclay.

Neuroradiology Unknowns

Vertigo Dr. Abdulrahman Alsanosi Associate professor Otolaryngology consultant Otologist, Neurotologist &Skull Base Surgeon Head of Otology / Neurotology.

Post-Concussive Dizziness: Concussion Recovery Program Majid Fotuhi, MD PhD HeadFirst Sports Injury and Concussion Care Silver Spring, MD January 22, 2014.

Show your best 3 Karl Clebak. Case Presentation  75 year old with rt shoulder numbness, lest sided trapezius muscle soreness fasciculation in left biceps.

Approach to Dizziness December 4, 2001 Swedish Family Medicine Dobrina Okorn, MD.

Head and Face. Anatomy  Eyes  Ears  Nose  Jaw  Mouth  Brain.

Trauma Case Conference Intern 賴柔吟. Patient Profile 彭 ○ 惠， 30y/o ， Female 彭 ○ 惠， 30y/o ， Female Chart No. ： Chart No. ： Date.

The Dizzy Patient 4x4 Method

NTUH Neurosurgery Morning Meeting Case Discussion Date: 2015/04/21 Presented by PGY 何御彰.

Case presentation Int:雲智謙

Dizziness and Vertigo Majid Fotuhi, MD PhD Suburban Hospital- Grand Rounds Lecture Bethesda, MD March 6, 2014.

Cases Neuroscience. Case 4 A 45 year old woman with a history of hypertension experienced a brief "blackout". She had complained of severe headaches,

Head and Face. Anatomy  Eyes  Ears  Nose  Jaw  Mouth  Brain.

Vertigo Dr. Abdulrahman Alsanosi Assistant professor King Saud University Otolaryngology consultant Otologist, Neurotologist &Skull Base Surgeon King Abdulaziz.

Stroke Damrongsak Bulyalert, M.D., Ph.D.

By Jolene Swoverland.  Occurs when a sudden trauma causes damage to the brain  Can be mild, moderate or severe  Can result when the head suddenly and.

Unit 8 Case Study. Case Study The wife of a 67-year-old man called the office and reported that her husband awoke this morning with weakness and numbness.

Morning Report Acute Ataxia 8/31/09 Lorena Muñiz, MD.

Control of eye movement. Third Nerve Palsy Eye “down and out”

2 John is a 57 year old man who developed gait difficulty which has worsened over the past months. He noticed that he needed to stand for apart to maintain.

Cases Neuroscience. 1. Which of the following structures is located at the irregularity indicated by the black arrow in the fissure shown in the image.

Case Presentation Beth Burlage. History 75-year-old male Reports constant dizziness and imbalance Problems initially began after a serious auto accident.

Chapter 32 Hearing, Speech, and Vision Problems All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

DOWNWARD SPIRAL Dizziness in Elders Presented by: Mary Sokolowski, BSN, RN.

David Johnson Staff Specialist, Emergency Medicine

NEUROPATHY Subsection B3 Francisco – Go, Kerby + Laxamana September 16, 2009.

Sports Injuries HEAD INJURIES. Head injury refers to any damage to the scalp, skull, or brain - Closed & Penetrating - Closed most relevant to sport Definition.

Vertigo Dr. Abdulrahman Alsanosi Associate professor Otolaryngology consultant Otologist, Neurotologist Head of Otology / Neurotology Unit Director of.

1 Evaluation of Dizziness Daniel Giuglianotti, D.O. PGY-2 UMDNJ-SOM Family Medicine Contributor: Deborah Simcox.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 24 Disorders of Hearing and Vestibular Function.

Vestibulitis, Labrynthitis, Meniere’s Disease, and Tinnitis Case Study

Cerebellar Ataxia Jose S. Santiago M.D..

HS 200: Diseases of the Human Body Dr. Allan Ayella Unit 8a Seminar Chapter 13 and 14.

PROF .DR.J.SANGUMANI M.D.,D.Diab

Fainting First Aid Mahmoud Maharmeh.

Vertigo Dr. Farid Alzhrani Assistant professor

ED: Case Study Review August, 2015 by Deborah Lynch, RN, MSN, APN, BC.

Vertigo Prof. Abdulrahman Alsanosi

Case 3 Headache & Slurred Speech Case Presentation

Morning Report October 26, 2010.

Dr Mohamad Shehadeh Agha MD MRCP(UK)

Posterior Stroke and the H.I.N.T.S exam

Bell Work- Page 91 What is a concussion? In what scenarios could someone get a concussion?

Presentation transcript:

Case discussion 2015/07/21 PGY 何御彰

Chief complaint Dizziness with mild nausea and vomiting for two days

Past history 60 F Hypertension (HTN) Paroxysmal atrial fibrillation (PAF)

Present illness Symptom Episodic dizziness with mild nausea and vomiting for 2 days It lasted more than 10 minutes and recovered spontaneously Provoking factor  Postural change Aggravating factor  Moving her head (X) Otitis 、 Drainage 、 Tinnitus 、 Aural fullness (X) Blurred vision 、 Slurred speech 、 Weakness (X) Diplopia 、 Dysarthria 、 Dysphagia 、 Weakness (X) Ataxia 、 Headache 、 Photophobia 、 Sonophobia

Present illness History (X) Barotrauma 、 Middle ear surgery (X) Recent hyperextension injury to neck (X) Recent viral infection (X) Phenytoin 、 Cisplatin 、 Aminoglycoside

Physical examination GCS = E4M6V5 Muscle power = 5 of 5 in all extremities Cranial nerve = Grossly normal without nystagmus Gait = Normal without ataxia Dix-Hallpike maneuver = No nystagmus Finger-Nose-Finger test = Bilaterally normal

Electrocardiogram

Treatment course Laboratory report WBC/Hb/PLT = 6.64/11.1/225 Cre = 0.5 Na/K = 140/3.7

Head CT

Brain MRI

Treatment course Medication Diphenhydramine 30 mg IF Sodium bicarbonate 49.8 mEq IV She felt better subsequently with less severity

Discussion Three-Step examination Horizontal head impulse test of vestibulo-ocular reflex function Observation of nystagmus in different gaze position Prism cross-cover test of ocular alignment Stroke Nov;40(11):

Discussion Ann Emerg Med. 2014;64: