A patient who had difficulty moving per head and looking at a computer screen. (Vestibulology Clinic).A 35-year-old woman reported an 8-year history of symptoms related to dizziness. At first, she had experienced a lightheaded feeling, which prevented her from working for approximately 3 weeks. She was prescribed meclizine meclizine /mec·li·zine/ (mek´li-zen) an antihistamine used as the hydrochloride salt as an antinauseant in motion sickness and to manage vertigo associated with disease affecting the vestibular system. , which provided some benefit. She also saw an allergist, who treated her for dust and mold allergy. Later, the woman's dizziness began to occur twice a year. The lightheadedness came ad went, but she learned to work through it. The lightheaded feeling occurred regardless of whether she was lying down, sitting, standing, or walking. She was treated with either meclizine or predinisone. Six weeks before her current visit, she developed severe upper airway congestion The condition of a network when there is not enough bandwidth to support the current traffic load. congestion - When the offered load of a data communication path exceeds the capacity. , which was accompanied by spells of lightheadedness that lasted anywhere from a few minutes to an hour. Eating would ease the feeling. The lightheadedness occurred during the day, but not at night. She was prescribed a nonsedating antihistamine antihistamine (ăn'tĭhĭs`təmēn), any one of a group of compounds having various chemical structures and characterized by the ability to antagonize the effects of histamine. , but it provided no relief after 10 days. She was switched to an antihistamine that contained pseudoephedrine, and she said it seemed to alleviate her symptoms. However, her symptoms returned when she stopped the drug. Another allergist informed her that her symptoms were not allergic. She then saw a neurologist, who ordered magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. and auditory brainstem response testing and who placed her on meclizine. At her current visit, the patient explained that she had difficulty moving her head and looking at a computer screen. She had no subjective hearing loss, but a constant aural fullness in the right ear had been present for 6 weeks, and it was accompanied by occasional binaural binaural /bi·nau·ral/ (bi-naw´r'l) pertaining to both ears. bin·au·ral adj. Having or relating to both ears. binaural pertaining to both ears. hissing tinnitus. The clinical neurotologic evaluation revealed that the patient experienced difficulty performing the sharpened tandem Romberg test with the left foot forward. She also had nuchal nuchal (nyōōˑ·k  l),adj pertaining to the posterior or nape of the neck. tenderness bilaterally. Electronystagmography revealed no spontaneous, positional, neck-torsion, or vertical nystagmus. The alternate binaural bithermal caloric test showed a reduced vestibular response (RVR) right of 13% and a directional preponderance of 25% to the right. The simulataneous binaural bithermal test showed a type 2 RVR right. From Neurotologic Associates, P.C., New York City New York City: see New York, city. New York City City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. . |
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