Short case 1

 58/M , welder by occupation, hailing from miriyalguda ,

came with chief complaints of giddiness since 3 days .

h/o present illness

he was apparently asymptomatic 3 days back when he developed giddiness which is gradual in onset, rotational, episodic, lasting for 30 sec to 1 min,  more on getting up from the bed or turning towards the right side, resolved spontaneously., increasing in frequency since 3 days , as he took leave from working and preferred to take more rest .

not associated with syncope,headache,hearing loss, nausea,vomiting, chest pain, blurring of vision,neck pain, sweating, palpitations,weakness of limbs, swallowing difficulty,

past history: no similar complaints in the past

no history of diabetes , hypertension,cerebrovascular disease, coronary artery disease.

 Personal history: 

Drug history: intermittent use of pantoprazole  40 mg for symptoms of belching ,bloating sensation especially after alcohol

Addictions: alcohol - whiskey 90 ml once or twice in one week for 30 years.

smoker- 5-6 ciggarattes per day for 20 years.


General examination:

pallor:absent

icterus:absent

cyanosis:absent

clubbing:absent

lymphadenopathy:absent

edema:absent

PR-82/min, regular 

BP-140/80mmg in right arm

supine and standing


Examination for giddiness

Dix Hallpike :

sypmtoms reappeared with a latency of 15-20 seconds on the right side

https://youtu.be/XkHOWCB-718

1) HINTS

head impulse: corrective saccades+on turning head to the right.

Nystagmus: absent.

Test of skew: negative in both eyes.

https://youtu.be/5z21hMpjiPQ

Higher mental functions: Intact

CRANIAL NERVE EXAMINATION:

1st   : Normal

2nd  :  visual acuity is normal

visual field is normal

colour vision normal

3rd,4th,6th  :  pupillary reflexes present.

EOM full range of motion present

5th             :  sensory intact

                     motor intact

7th             :  normal

8th             :  Weber's:no lateralization

                       Rinnie's: normal.

9th,10th     : palatal movements present and equal.

11th,12th   : normal.

 Cerebellum: 

      Tone of limbs:normal

       no involuntary movements

       finger nose test : able to perform both sides

      finger finger test:able to perform both sides

     knee heal test:able to perform both sides

     dysdidokinesia: absent

https://youtu.be/N-lnudS12iA

     rebound phenomenon:

     pendular knee jerk:absent

https://youtube.com/shorts/zmJGi-29hZk?feature=share

    tandem gait:normal

https://youtube.com/shorts/Pqqi6hELDsY?feature=share

    

Rhomberg's test:negative

Sensory system:

fine touch.                          present.                           present 

joint position.                    present.                          present 

vibration.                              present.                          present

crude touch.                        present.                          present

pain.                                        present.                            present

temperature.                      present.                            present

No orthostatic hypotension.

CVS: 

Apex beat:5th ics in mid clavicular line

no heave 

S1 and S2 heard in all areas


R.S: normal vesicular breath sounds heard

GIT: no tenderness,organomegaly or free fluid.


Investigations

ECG:normal sinus rythmn 



electrolytes

Sodium-143meq/L

potassium-4.2meq/L

chloride-92



complete blood picture:

hb-12.3 gm/dl

tlc-8200 cells/mm3

plt-2.3 lakh


management:

epley's maneuver done- reduction in symptoms observed.

https://youtu.be/zfCdEtBYCFQ


Final diagnosis

vertigo 

secondary to peripheral lesion in the vestibular apparatus.

 likely BPPV (benign paroxysmal positional vertigo).


Treatment

Tab vertin 8 mg /po/tid 

       




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