65 F postural dizziness and vomiting
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CASE :
65 year old housewife from Nalgonda Chief complaints-dizziness and Vomiting 5 episodes 3 days ago
History of present illness-
Patient was apparently alright 1 year back then developed vomiting associated with giddiness and pain. she came to our hospital and vomiting subsided with treatment. She was asked to take Vertin 24 (betahistine) at discharge. she took the medication for 3 months and then stopped after consulting with her physician. She had mild episodes of vomiting for the next months until 3 days back when she had 5 episodes (severe)
Vomiting-
non projectile, contents were food/watery. there was no blood present in the vomitus. no temporal association with meal timings was noticed. it was associated with giddiness and colicky, non radiating pain in the epigastrium, present only during the episode. Not associated with fever, diarrhea or constipation.
Frequency of stools are normal but volume is decreased due to less food intake out of fear of vomiting.
No history of- abdominal distention, heart burn, acidity, excessive flatulence, jaundice.
Giddiness- there was no history of trauma, fall, stroke, aural fullness, tinnitus, no positional variation or triggering factors (starts randomly). no aggravating factors. relieved with medications.
Past history-
Patient is a known case of hypertension since 5 years, is on medication Telma 40.
No history of tuberculosis, diabetes mellitus, stroke.
Personal history-
Mixed diet
Reduced appetite
Adequate sleep
Bowel movements are of normal frequency but reduced volume
Bladder movements are normal
No addictions or allergies
Occasionally drinks toddy.
Daily routine (premorbid)
5:00 AM- wakes up
5:00 -6:00AM- gets ready
7:30AM - Chai + bun
7:30-10:30AM- stays indoors, doesn't do much
11:00AM- Rice+ curry
1:30PM- Buttermilk+rice
1:30-8:00PM- stays indoors, doesn't do much
8:00PM- Rice+curry
10:00- sleep
morbid changes- doesn't eat much due to fear of vomiting, however, small meals are consumed regularly.
Family history-
No similar complaints in the family. no history of HTN or DM in the family.
General examination-
Patient is concious coheret cooperative and oriented to time place and person.
built- average
nourishment- average
Pallor is present.
icterus, cyanosis, clubbing, lymphadenopathy or edema are absent.
Temperature- Afebrile
PR- 78 bpm, regular, normal volume, normal character, no radioradial delay, no radiofemoral delay.
RR- 17 cpm
BP- 130/80 mmHg
Decreased range of motion of neck flexion
Fixed flexion deformity of bilateral knees with left being more then right.
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Systemic examination-
Per Abdomen-
Inspection-
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Shape - flat
flanks- empty
umbilicus- inverted
striae gravidarum present.
normal movements with respiration
no visible pulsations, peristalsis, or hernial orifices
abdominal girth-
palpation-
no local rise of temperature or tenderness in any quadrant. no guarding or rigidity. lver and spleen were non palpable.Percussion- no shifting dullness or fluid thrill present.
Auscultation- Bowel sounds heard.
Central nervous system-
Concious, Coherent, Cooperative, orientated to time, place, person
memory- recent memory impaired
speech- Normal
Gait- short steps with broad base
Cardiovascular system-
S1, S2 heard, no thrills or murmurs
Respiratory system-
Bilateral air entry present, normal vesicular breath sounds heard, no added sounds.
Provisional diagnosis-
Vertebrobasillar insufficiency.
Differential diagnosis-
benign paroxysmal positional vertigo, meniers disease, vestibular neuritis, cerebellar palsy, multiple sclerosis.
Investigations-
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INJ OFER 4mg IV
INJ PAN 40mg IV
TAB TELMA 40mg PO
TAB PREGAM mg
TAB SHELCAL CT
TAB VIT D2
TAB SUPADYN
IV FLUID NS PO OD
BP, PR, TEMP motoring
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