Case Presentation Son Eui Young 2007313075 Sungkyunkwan University

Case Presentation Son Eui Young 2007313075 Sungkyunkwan University School of Medicine

Chief Complaint n F / 56 n Dizziness – Onset : 1 days ago

Personal History n Past medical history – Hypertension/DM/TB/hepatitis/Allergy(-/-/-) – 2 weeks ago URI History (+) n Medication – No n Family history – Hypertension/DM/TB/hepatitis/Cancer(-/-/-) n Social history – – – Occupation: 주부 Smoking: No Alcohol: No

Review of System n n n General Weakness(-) Fatigue/ Weight change(-/-) Fever/Chill/Night sweat(-/-/-) n n n Headache/Dizziness(-/+) Visual disturbance/occular pain(-/-) Sore throat/Rhinorrhea/Sneezing(-//-) Cough/Sputum (-/-/-) Dyspnea/Hemoptysis (-/-) Chest pain (-) Palpitation (-) n n n Abdominal pain (-) Anorexia/Nausea/Vomiting(-/+/+) Constipation/Diarrhea(-/-) Melena/hematochezia/ hematemesis (-/-/-) Dysuria/Frequent voiding(-/-) Red urine/Foamy urine(-/-) Arthralgia/Myalgia (-/-) Morning stiffness(-/-/-) Easily bruisilibility (-)

Physical Examination n Vital sign – n n n – BP 116/74, HR 70, RR 20, BT 36. 5℃ General appearance: Not so illlooking Mental state: alert & well oriented Chest – – n Skin – n Head and Neck – – – – – Pinkish Conjunctiva/ unicteric Sclera Isocoric Pupil size, prompt light reflex at both eyes Nystagmus (+, Rt) Otoscopy (정상)) oral ulcer ( - ), tongue dehydration ( - ) Tonsilar hypertrophy( - ), Pharyngeal injection( - ) Cervical LNE( -); Thyroid enlargement ( - ) Carotid bruit Rt/Lt ( - / - ) Paranasal tenderness ( - ) Symmetric expansion, Vesicular Breath sound s wheezing Regular heart beat s murmur Subclavicular node / Axillary node ( - / - ) Rash/Purpura/erythema (- / - )

Problem List n #1. Dizziness n #2. Nausea / Vomiting n #3. Nystagmus (+, Rt)

Assessment n n #1, 2, 3 : #1 : Vestibular neuritis Benign paroxysmal positional vertigo Meniere disease Stroke Migraine Epilepsy (no positional change) (청력저하, 이명, 이충만감 없음) (다른 신경학적 이상 없음) #1. Dizziness #2. Nausea / Vomiting #3. Nystagmus (+, Rt)

Diagnostic Plan n Full Neurologic exam – 동반 될 수 있는 신경학적 징후를 확인 n Audiogram – 청력이상 확인 n Brain MRI – r/o Stroke

Therapeutic Plan n For relieving symptoms – – n antiemetics, vestibular suppressant Metoclopromide 10 mg PO or IM tid Dimenhydrinate 50 mg /q 4 -6 hours Diazepam 2 -10 mg PO, IM or IV PRN, or 2 mg PO bid 48시간 이상 지나도 어지럼증이 전혀 호전되지 않거나 악화시 – CNS 문제 감별 위한 검사 필요(Imaging)

Disease Review 전정신경염 (Vestibular neuritis)

Definition Vestibular labyrinth 3 semicircular canals 회전감 Otolith organs (utricle + saccule) 기울어짐