Dreaded Dizzy

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A 40s M presents with headache and dizziness.  The symptoms have been going on for 2-3 days.  The headache started first.  It is mild, diffuse, and slow onset (non-thunder clap) in nature.  He gets headaches now and then, but not frequently.  There is no nausea or vomiting.  The dizziness sounds more like vertigo than lightheadedness /near-syncope.  He describes a feeling of unsteadiness, not necessarily spinning, and it is somewhat positional, though the description appears to be orthostatic at times.  There are no ear / ent complaints.  He states he may have blacked out last night when he had an episode of dizziness that was very brief.  There is no recent illness, chest pain, sob, or abd pain.  He has no pmh / psh or meds.

On exam, he has normal VS.  He was examined by a med student, the chief, the pretending, and an attending.  During one of the H&Ps, someone thought he may have had mild truncal ataxia.  When everyone returned as a group to examine him, his gait is normal, and it should be noted that he was walking around in the ED while he was waiting for his labs / ekg, which are all normal.

What do we do now?

One Comment

  • jerryguzik

    If MRI is available just do it and get it over with. He’ll end up getting it eventually. CT is an option if MR is not happening in the near future but will probably be low yield since this is more likely a posterior fossa problem.

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