Concluded Case

Vertigo for evaluation

40 years female with vertigo Chief Complaints History of vertigo - since last more than 2 years History In June - she had hysterectomy done under spinal anesthesia. 15 days after surgery she developed severe vertigo- which is continuing till today All treatment in this regard failed having received beta - histine, cinarrizine , prochlorperazine etc Vitals Temp - 98.5 °F Pulse - 100 / minute , regular , no abnormal character B.P - 140 / 80 mm of Hg . Physical Examination NAD Investigations MRI scan of Brain - normal MRI scan of cervical spine- normal Diagnosis Vertigo - Exact cause not detected yet Management Considering her anxiety and tachycardia- ECG was advised She is put on Tab Prochlorperazine B.D Tab betahistine 16 mg B.D Tan Cinnarizine B.D Tab Etizolam.0.25 mg + propranolol 20 mg O.D Comments on ECG are welcomed

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Sir dr Praveen Yograj Good morning Ecg of pt is absolutely WNL Two points Certainly she is a c/o BPVV Aggravated or induced after spinal anaesthesia 2 such pts are clinicopathologically are normal but physiologically always problem Rx combinations can be continued with periodical withdrawals or upgraded Cervical collar and traction are important for at least 6months Avoidance of high neck pillows bolsters or excessive working on digital devoices Eyesight checkup and correction of REBE is also important Last but not least daily neck shoulder exercises (guarded) with pranayams and lifestyle are to be observed or advised

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Vertigo needs more history. Continuous or intermittent vertigo,subjective/ objective in nature,any associated tinnitus,deafness,nausia ,vomiting. What about the vertigo with position of head and neck. Is it associated with head ache etc. Most probably benign paroxysmal positional vertigo needs good history.

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Sir dr Praveen Yograj Good morning Ecg of pt is absolutely WNL Two points Certainly she is a c/o BPVV Aggravated or induced after spinal anaesthesia 2 such pts are clinicopathologically are normal but physiologically always problem Rx combinations can be continued with periodical withdrawals or upgraded Cervical collar and traction are important for at least 6months Avoidance of high neck pillows bolsters or excessive working on digital devoices Eyesight checkup and correction of REBE is also important Last but not least daily neck shoulder exercises (guarded) with pranayams and lifestyle are to be observed or advised

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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LOOKS LIKE - Benign paroxysmal positional vertigo BPPV BPPV is most common cause of vertigo - Epleys manoeuvre bring about permanent relief in case of BPPV

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A literature search was performed using articles published in PubMed on August 1, 2020, to identify dizziness as a clinical manifestation of COVID-19. The keywords used for the article search include giddiness, dizziness, vertigo, COVID-19, SARS CoV 2, Coronavirus disease. To our knowledge, this is the first article that outlines the association between dizziness and COVID-19. Could this also be a possibility? please comment

Not a possibility in this case because patients history is of 2 years old and 2 years back Corona virus was not present
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NSR Sinus tachycardia RAD Otherwise normal ECG ENT opinion needed with audiogram to exclude Minieres disease. Low dose Betahistine maintenance dose for a few months. Vertebral angiogram if suggested by neurologist

Vertigo. Needs further investigation and evaluation to conclude. physical examination of ear eyes nose with MRI of brain can be conclusive. Physiotherapy and stability of neck advisable.

S1 , p pulmonale Low voltage complex. Possibly RV strain. Adv Echo CD.

Looks like Pseudovertigo or BPPV... treat accordingly..

Ecg shows no acute ST-T changes,considered normal. needs neurological examination for further assesment and management.

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