From the Guidelines
The patient should restart the previously effective medication if available, or consider vestibular suppressants like meclizine 25mg every 6-8 hours as needed for acute symptoms, and follow up with Dr. Sabonia as soon as possible to reassess her vertigo treatment plan and address the worsening symptoms. The patient's symptoms of triggered vertigo for two years, which have worsened with head movement over the past couple of weeks, suggest possible benign paroxysmal positional vertigo (BPPV) or another vestibular disorder 1. Given the patient's history of vertigo and the recent worsening of symptoms, it is essential to reassess her treatment plan and consider further evaluation or referral to a specialist if necessary. The patient should also seek treatment for her UTI with appropriate antibiotics based on urine culture results, typically a 3-7 day course depending on the specific antibiotic prescribed. Additionally, the patient should reschedule her cardiology appointment, as cardiovascular issues can sometimes contribute to vertigo symptoms 1. Vestibular rehabilitation exercises may help reduce vertigo frequency and severity over time. The patient's symptoms and history should be carefully evaluated to determine the best course of treatment and to rule out any underlying conditions that may be contributing to her vertigo.
Some key points to consider in the patient's treatment plan include:
- Reassessing her vertigo treatment plan and addressing the worsening symptoms
- Considering vestibular suppressants like meclizine for acute symptoms
- Seeking treatment for her UTI with appropriate antibiotics
- Rescheduling her cardiology appointment to rule out any underlying cardiovascular issues
- Considering vestibular rehabilitation exercises to reduce vertigo frequency and severity over time
- Evaluating the patient's symptoms and history to determine the best course of treatment and to rule out any underlying conditions that may be contributing to her vertigo 1.
From the Research
Patient's Symptoms and History
- The patient reports experiencing vertigo for the past two years, with symptoms worsening over the last couple of weeks, particularly with head movement 2, 3.
- The patient has been taking medication that provided some relief, but the name of the medication is unknown.
- The patient is being treated by Dr. Sabonia, but the date of the next appointment is unclear.
- The patient's symptoms have been consistent over the past two years, but have worsened slightly over the last couple of weeks.
Classification of Vertigo
- According to the study by 2, vertigo can be classified as continuous or episodic, and further categorized as post-exposure or spontaneous.
- The patient's symptoms can be classified as episodic, triggered by head movement, which suggests a peripheral cause of vertigo 3.
- However, the patient's symptoms could also be indicative of a central cause, such as a stroke or posterior fossa tumor, particularly if accompanied by other central neurological symptoms and signs 3, 4.
Diagnostic Approaches
- A thorough otoneurological evaluation, including assessment of nystagmus patterns and the vestibulo-ocular reflex, is essential for determining the cause of vertigo 3, 5.
- Imaging studies, such as MRI or CT scans, may be necessary to rule out central causes of vertigo, particularly if clinical findings are inconclusive 3, 4.
- Bedside tests, such as head-shaking nystagmus and rapid head impulses, can help detect deficits in labyrinthine function 5.
Current Condition
- The patient currently has a UTI, which may be unrelated to the vertigo symptoms.
- The patient had a cardiology appointment 2 months ago, but cancelled it, which may be relevant to the patient's overall health status.
- The patient was educated on the importance of seeking emergency care if symptoms worsen, but refused to go to the ER and signed AMA paperwork.