Case Study: Dizziness in a 42-year-old man

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You receive sign-out from a colleague in the emergency department, and one of the patients is a 42-year-old man who came in for vertigo. His workup, including a CT scan, is negative and he is discharged home with a diagnosis of peripheral vertigo. He has been given meclizine, which helped, and is just waiting for a ride. The nurse later comes to you, asking you to check on him because he is having a lot of trouble walking. He tells you that he has had 6 hours of constant vertigo that is worse with head motion and better with his eyes closed. He vomited twice but has no headache, abdominal pain, or other complaints.

Examination

Vital signs are all normal. He is having trouble walking due to vertigo/ataxia. He also has trouble performing an extra-ocular movement exam because he says it makes him dizzy. You think that you note nystagmus, but he cannot keep his eye focused long enough for you to feel confident in your examination.

Testing

His CT scan is shown below. 

What does the CT show? 

What if any other evaluation should you consider before discharge home? 

Click to the next page for answers 

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