Question

A 50-year-old woman is admitted with chief complaints of headache and decreased range of motion in her neck. She also complains of vertigo, hearing loss in one ear, profuse sweating, and uncontrollable eye movements. Her past medical history indicates that she was in a motor vehicle accident three days before her admission.

• What specific diagnostic examinations would you recommend? Why?
• What conditions should be ruled out? Why?
• How would you distinguish between these conditions? What are the possible causes of these symptoms?

Answer 1

1. Keeping in mind patient’s symptoms of headache, vertigo, hearing loss in one ear, profuse sweating, and uncontrollable eye movements CT scan and MRI of brain is recommended to check for any brain bleeds, hematoma, brain herniation, swelling or tumor.

Cervical Xray is required to check for any cervical fracture which may cause reduced ROM of neck.

ENT examination and electronystagmography for hearing loss and nystagmus.

Thorough eye examination is also required.

2. The patient have a history of motor vehicle accident. She also exhibits symptoms like headache, vertigo, hearing loss in one ear, profuse sweating, and uncontrollable eye movements. These symptoms raise doubt for traumatic brain injury or spinal cord injury.

The conditions that need to be ruled out include haematoma, brain herniation, spinal cord injury, brain hemorrhage, neck or skull fracture, injury to internal ear or tympanic membrane, acute cerebellar ataxia.

3. The above mentioned conditions can be distinguished based on associated symptoms and diagnostic reports.

Any brain bleed or herniation can be seen on brain MRI and CT scan.

If there is spinal cord injury, there will be weakness or parslysis of limbs.

In case of cerebellar ataxia, balance and coordination would be impaired.

Possible causes of above mentioned symptoms include trauma to head, motor vehicle accidents, brain infections stroke, brain herniation, spinal cord injury, skull fracture, hydrocephalus.