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 day before her admission.
What specific diagnostic examinations would you recommend? Why?
What conditions should be ruled out? Why?
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How would you distinguish between these conditions? What are the possible causes of these symptoms?
With chief complaints of headache and neck stiffness post MVA, I would first order a CT of the brain and cervical spine. This imaging would be pertinent to rule out possible CVA, brain injury, and neck fracture. There is also a strong chance that the patient has whiplash or a concussion. More information would have to be given to determine if the patient actually hit her head, or if she was rear-ended, to direct plan of care.
The patient does exhibit some symptoms of a concussion, so this must be ruled out. “The signs of a concussion may include: memory problems, confusion, drowsiness or feeling sluggish, dizziness, double vision or blurred vision, abnormal eye movement, headache, nausea or vomiting, sensitivity to light or noise, balance problems, slowed reaction to stimuli, post traumatic vertigo, or dizziness that lasts up to several months” (Healthline Media Editorial Team, 2017). A traumatic brain injury must be ruled out as well especially since the patient exhibits with the symptom of profuse sweating. “Sweating disorders after traumatic brain injury are common with multifactorial causes including injuries, tumors, infarcts, or hemorrhages of the brain or medulla” (Garg, A. Malhotra, R., 2016). Whiplash would also be a possible diagnosis and is very common after MVAs. This would be the less severe diagnoses. “About 80% of the cases of whiplash injuries recover within a few months. However, about 15-20% (about 40,000 cases per year) develop “late whiplash injury syndrome”. This syndrome involves complaints including neck pain, headache, vertigo, hearing loss and tinnitus. Hearing loss, tinnitus and dizziness are the main ontological symptoms of whiplash” (Arches Natural Products, 2018).
Along with imaging, it would be priority to conduct a thorough neuro exam and assess cranial nerves. I would ask if the patient is on any anticoagulants and have basic blood work drawn. Once this data is gathered, the physician should be able to narrow it down and form an accurate diagnosis to treat the patient.
Arches Natural Products (2018). Tinnitus Library: Head and Neck Injuries Cause Tinnitus: Part Two. Retrieved from: https://www.tinnitusformula.com/library/head-and-neck-injuries-cause-tinnitus-part-two/
Garg A, Malhotra R (2016) Sweating Disorder after Traumatic Brain Injury. J Anesth Clin Res 7:695. doi: 10.4172/2155-6148.1000695
Healthline Media Editorial Team (2017). Healthline Newsletter: Concussion. Retrieved from https://www.healthline.com/health/concussion
Jarvis, C. (2016). Physical Examination and Health Assessment, 7th Edition. [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9781455728107