FEATURE: HANNAH GRACHEK, PA-C; KELLY S. REED, PharmD, MPA, PA-C
Atypical Posterior Stroke: Diagnosing Cause of Vertigo in Primary Care A patient presenting with dizziness undergoes a thorough workup to identify a peripheral or central cause of vertigo.
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57-year-old woman presents to her primary care provider with complaints of dizziness, which began 3 hours ago and is continuous. She describes the dizziness as a room-spinning sensation that is not relieved or associated with any particular position. The dizziness is associated with headache, nausea, vomiting, weakness, and loss of balance. She rates the dizziness severity as an 8 out of 10. The patient denies fever, chills, fatigue, night sweats, weight changes, head injury, tinnitus, hearing loss, otorrhea, otalgia, vision changes, recent upper respiratory tract illness, or syncopal episodes. She states she has never experienced anything like this before. The patient’s medical history is significant for morbid obesity (body mass index, 48), type 2 diabetes, hypothyroidism, and hyperlipidemia. She notes that she does not exercise and that her diet consists of fast food most days of the week. She admits to occasional alcohol use once or twice a month and denies tobacco or drug use.
Examination
Example of an MRI in a patient with posterior ischemic stroke.
The patient appears disheveled but alert and oriented to person, place, time, and situation. Vital signs are shown in Table 1, page12. Her head and face are symmetrical with no signs of ptosis or facial droop. Eye examination (pupil, equal, round, reactive to light) is normal, and ophthalmoscopic examination shows initial signs of cataracts bilaterally. No exudates, hemorrhages, www.ClinicalAdvisor.com • THE CLINICAL ADVISOR • JANUARY/FEBRUARY 2022 11
