Dizziness: The first step to a widespread diferencial diagnosis
MEDICAL HISTORY
We report a 43 years old female, that only refered in her medical history Dyslipidemic disorder treated with Simvastatina as unique chronic treatment.
She comes to our Emergency unit with complaints of three progressive weeks with motion dizziness, wich not suffered modifications with oculocefalics movements or postural changes. She refered add more instability in orthostatic position making proper wandering impossible.
For these same symptoms towards seven days the patient had been atended, and had been diagnosed by Periferic Vertigo and treated with Betahistine and Tryptizol without presenting improvement.
Our patient not refered fever, nausea, vomiting in any moment of her process.
Upon arrival at Emergency unit, she showed Blood pressure 153/75 mmHg, FC 81 bpm.
The physical exploration showed good general condition and normal cardiopulmonary auscultation. The neurological exploration showed ischoric and normorreactive pupils, oculocefalic motors cranial pairs conserved, no nistagmus, no dismetrías or dysdiadochokinesis, negative Romberg, and unstable march with bilateral lateralization and increase in the support base.
Between the complementary tests we did this day, there were ECG, blood analysis and chest x-ray without patological findings.
Finally we proceed to urgent craneal TAC with the following finding: Posterior fossa tumor that settle in left cerberlossus hemisphere suggestive of Ceberlossus Hemangioblastoma, producing mass effect on Protuberance and Bulb, colapsand the peritroncularcisterns and parcial IV ventricle, giving place to Obstructive Hidrocephalus asociate.
Half an hour later the patient started to presents a decrease in the level of consciousness and was derived urgently to neurosurgery service in our reference center.
CONCLUSIONS
The Dizziness is a comun reason for consultation in Emergency units every day. Most of time is an unspecific symptom, complicated to frame in a concrete syndrome.
The higher percentage of cases is due to bening etiology, but there are some cases outcome to potentially lethal causes, that we should to be able to perceive. It´s essential to point out the need of re-evaluation, re-interrogation and re-exploration, added to a rethinking hipothesis diagnosis, wich is developed by professionals in Emergency units, through a exhaustive anamnesis and a special holistic vision of the patient, the medical situation and pathology background.
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