35 years male complaining of CHAKKAR since last one month ...intermittent in nature...but sometimes so severe to to normal activities...He was treated for Jaundice 2 years back...Occasional alcoholic....Tobacco chewer....Vitals are with in limit...His Hb and WBCs are on lower side...kindly give your valuable opinions in this case....

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VERTIGO ----------------- HE HAS IRON DEFICIENCY ANAEMIA 7 . 6 GM / DL CAUSE = DIETARYBDEFICIENCY BLOOD LOSS MALENA ? THALASSAEMIC CARRIER ? B P REPORTED NORMAL HEARING ,? RRCURRENT VERTIGO WITH INCREASING DEAFNESS CAN BE MINEARE'S DISEASE VESTIBULAR FUNCTION TO BE DONE HALLPIKE MANUAVRE CALORIC TEST OPTOKINETIC TEST NYSTAGMOGRAM ALCOHOLIC = VITAMIN B 1 DEFICIENCY TO BE LOOKED FOR ALSO B12 LEVEL B12 DEFICIENCY CAN CAUSE VESTIBULAR NEUROPATHY LOOK FOR PLANTERS & CEREBELLAR DYSFUNCTION FINGERNOSE TEST ROMBERGS TEST DYSDIADOCOKINESIA

Pt have any complaints about EAR pain?

No..he doesn't
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Microcytic hypochromic Anemia with increased red cell distribution width - Iron deficiency anemia Chakkar can be due to Anemia. Usually chronic And slow insidious blood loss patient don't have chakkar at 7-8 hb, so he might be losing blood in spurts or has been losing recently. So is there any history of hemhorroids or bleeding from any other site. The other cell lines are also on the lower side. So first will be anemia work up Iron profile Serum B12, Serum folate. Serum BIL There is a history of jaundice 2 years back and there are tear drop cells . HBsAg

Thank you very much...Nice explanation Yes..Pt is having history of Hemorrhoids... Why WBCs are on lower side?
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Thank you very much to all of you....

its otolithiasis ... probably.

It's a case of vertigo with anaemia microcytic hypochromic D/D 1. Iron deficiency anaemia 2. Thallessimia minor 3. Chronic kidney disease We should rule out causes of micytic hypochromic anaemia. Should send sample for A. Iron profile for details iron study B. Hb electrophoresis for thallessimia minor C. Renal function test for CKD THEN TREAT ACCORDINGLY

Stool exam for occult blood andMRIabdomen& lft.Also rule out fatty liver &cirrhosis.Must do endoscopy to see polyps & other bleeding point.Tt on line so to prevent hepatic failure.

It may be a bppv( benign proximal positional vertigo). Ask patient which type of vertigo he feel like when position change or any time?

No...he doesn't feel so
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It is a simple case of iron deficiency anemia with vertigo. Best course will be to correct anemia and manage piles. Body will take care of any Chakkars once anemia is corrected.

It seems to be a case of anaemia iron deficiency ......anaemia is also a cause of chakkar n weakness

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