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Suggest Treatment For Vertigo, Hearing Loss, Involuntary Eye Movements And Profuse Sweating
Question: A 50-year-old woman is admitted with chief complaints of headache and decreased range of motion in her neck. She also complains of vertigo, hearing loss in one ear, profuse sweating, and uncontrollable eye movements. Her past medical history indicates that she was in a motor vehicle accident three days before her admission.
What is the probable diagnosis for this woman and what treatment would be considered? What labs and examinations would be completed to diagnose?
What specific diagnostic examinations would you recommend? Why?
What conditions should be ruled out? Why?
How would you distinguish between these conditions? What are the possible causes of these symptoms?
What is the probable diagnosis for this woman and what treatment would be considered? What labs and examinations would be completed to diagnose?
What specific diagnostic examinations would you recommend? Why?
What conditions should be ruled out? Why?
How would you distinguish between these conditions? What are the possible causes of these symptoms?
Brief Answer:
Stroke due to vertebral artery dissection must be considered.
Detailed Answer:
I read your question carefully and I understand your concern.
In this setting my first thought would be a stroke in the posterior brain area (brain stem and cerebellum) due to a dissection of a vertebral artery from the accident she's had. The vertebral arteries are the vessels which supply the posterior part of the brain. A dissection is a tear in the vessel wall which can lead into blood accumulation in the wall, narrowing of the vessel, formation of thrombi which could migrate and cause a stroke in the territory these vessels supply. Trauma (at times even minor) can be one of the main causes for dissection.
The diagnosis must be searched for ideally through MRI with angio MRI of the brain and neck vessels. If not promptly available in the ER, CT with angio CT can make the diagnosis as well. Treament usually consists in blood thinning products, but imaging is necessary before, there might be complications like subarachnoid hemorrhage which might complicate decisions and make considerations for endovascular or neurosurgical treatment necessary. So imaging first, then step by step.
If imaging on the other hand results normal, a more benign cause could be inner ear issue. Her headache, decreased neck range of movement and accident history make that less likely though, dissection and stroke must be thoroughly investigated first.
I hope to have been of help.
Stroke due to vertebral artery dissection must be considered.
Detailed Answer:
I read your question carefully and I understand your concern.
In this setting my first thought would be a stroke in the posterior brain area (brain stem and cerebellum) due to a dissection of a vertebral artery from the accident she's had. The vertebral arteries are the vessels which supply the posterior part of the brain. A dissection is a tear in the vessel wall which can lead into blood accumulation in the wall, narrowing of the vessel, formation of thrombi which could migrate and cause a stroke in the territory these vessels supply. Trauma (at times even minor) can be one of the main causes for dissection.
The diagnosis must be searched for ideally through MRI with angio MRI of the brain and neck vessels. If not promptly available in the ER, CT with angio CT can make the diagnosis as well. Treament usually consists in blood thinning products, but imaging is necessary before, there might be complications like subarachnoid hemorrhage which might complicate decisions and make considerations for endovascular or neurosurgical treatment necessary. So imaging first, then step by step.
If imaging on the other hand results normal, a more benign cause could be inner ear issue. Her headache, decreased neck range of movement and accident history make that less likely though, dissection and stroke must be thoroughly investigated first.
I hope to have been of help.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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