Morning Report

Morning Report: Dizziness

Resident Presenter: Sam Lu

Summary : 47 year old male with Hx of MS presents with persistent, moderate, dizziness that began earlier in the night. He had an episode of lightheadedness, nausea, and diaphoresis followed by multiple bouts of vomiting.  Now complaining of burning abdominal pain and vertigo with room spinning, which is worse when he sits up in bed.  Vitals show BP of 125/64, Pulse 72, temp 98, resp 16, O2 sat 98%. He has no tinnitus, no ear pain, no nystagmus, no focal neuro deficit. Patient received a dose of zofran, reglan, and meclizine plus 3 bolus of fluids before he felt comfortable enough for discharge.

Learning Points:

  1. Central vs Peripheral vertigo:
    • Onset: sudden (P) Sudden or slow (c)
    • Severity: Intense spinning (P) Ill defined (c)
    • Pattern: paroxysmal, intermittent (P) Constant (c)
    • Aggravated by position: Yes (P) Variable  (c)
    • Nystagmus: Rotary-vertical, horizontal (P) Vertical (c)
    • Fatigue of symptoms: yes (P)   no  (c)
    • Hearing loss/tinnitus: maybe (p) no  (c)
    • Abnormal TM: maybe (p) no  (c)
    • CNS symptoms: Absent (p)    usually  (c)
  1. How to perform Dix-Hallpike maneuver. Sensitivity 50-80%
  2. Pharmaceutical treatment for vertigo: Scopolamine patch (anti-cholinergic) 1st line, Meclizine/Benadryl (antihistamine) 2nd line, Reglan/Phenergan (anti-dopa) 3rd Zofran only for brainstem disorders and MS.

EBM Article:

Michael D. Brown, MD, MSc (EBEM Commentator) Is the Canalith Repositioning Maneuver Effective in the Acute Management of Benign Positional Vertigo? Annals of Emergency Medicine Volume 58, Issue 3, September 2011, Pages 286–287

Tintinalli. 7th Edition. Vertigo and Dizziness


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