CASE 46: NAUSEA AND VERTIGO
History
A 17-year-old woman is admitted to the emergency department complaining of severe
vertigo. This has developed over the past few hours and previously she was well. She has
the sensation of her surroundings spinning around her. She feels nauseated and sleepy.
She does not have a headache. She has not had any previous medical illnesses. She is a
non-smoker, and says that she does not drink alcohol or take recreational drugs and she
is taking no regular medication. She lives with her parents and is due to sit her A-levels
in 3 weeks. Her father suffers from epilepsy and her mother has hypothyroidism.
Examination
She is drowsy and her speech is slurred. Her pulse rate is 64/min, blood pressure 90/70 mmHg
and respiratory rate 12/min. Examination of her cardiovascular, respiratory and abdominal
systems is otherwise normal. Her peripheral nervous system examination is normal apart
from impaired co-ordination and a staggering gait. Funduscopy is normal. Her pupils are
equal and reacting. There is a normal range of eye movements but she has multidirectional
nystagmus. Her hearing is normal as is the rest of her cranial nerve examination.
Questions
- What is the diagnosis?
- What are the major differential diagnoses of vertigo?
- How would you manage this patient?