ndaisyk Posted May 18, 2010 Share Posted May 18, 2010 I am in need of some feedback. Any info you share is greatly appreciated! S CC: 53 y/o male pt with CC of "eyes jumping" x 4 years HPI: My 53 year old male pt presented last month with c/o "eyes jumping." After exploring this symptom, he describes it like he feels his eyes moving back and forth quickly and his vision blurs; this causes dizziness and nausea. There is no associated pain. This can happen with activity, or at rest. During activity, he has to stop what he's doing and drop to one knee or lean against a wall to keep himself from falling over due to dizziness. He states that closing one eye helps him not feel so dizzy, too. Episodes can last anywhere from a few seconds to 10 to 15 minutes. The last episode lasted 20 minutes and was so severe, he had to lie down. The pt states this started 4 years ago, and has increased in frequency to 2 times a month, presently. He reports some episodes of tinnitus which are unrelated to the above scenario. Of note, he does not endorse true vertigo. SHx: mechanic, 30 pack year hx, quit 5 years ago. divorced. Rare ETOH use. PMH: hyperlipidemia, GERD, seasonal allergies MEDS: loratadine 10mg qd Simvastatin 20 mg qd omeprazole 20 mg qd Elestat eye drops BID Fhx: Mom; DMII, DV dz, HTN, COPD Dad; died of MI at age 64 NO ALLERGIES ROS: no SOB, chest pain. No hx of migraines or migraine -like headaches. No hx of concussion. No reported hearing loss. No c/o pain. O PE: 220 lbs 70.5 inches 130/88 HR 82 Temp 97 resp 20 O2 sat 94% skin: without lesions HEENT head: normocephalic eyes: PERRL EOMI without nystagmus ears: TM intact bilaterally, non-erythematous nose: nares patent bilaterally, without rhinorrhea throat/neck: no lymphadenopathy, uvula mid-line lungs: CTAB, without wheeze, crackles cor: RRR, no murmur ext: no edema data: CBC: HCT, MCV, and MCH elevated; 53.3, 96, 32.1, respectively. Remainder nrml PSA: 2.99 CMP: Glu 113, remainder nrml A1C:5.8 Cholesterol: Trig-160 TC-203 HDL-45 calc LDL-126 VLDL-32 Chol/HDL ratio-4.51 nrml CT angiogram of the Circle of Willis CT scan, head: without abnormalities ophthalmologist consult: dx of ocular migraine A/P: My next idea is to rule out causes of vertigo, even though he doesn't have true vertigo. Also, I am disinclined to endorsing the dx of ocular migraine, as his visual symptoms are bilateral, whereas ocular migraine symptoms are unilateral; I am going to call another ophthalmologist and present this case. If you've seen this in practice, please share any ideas. THANKS!!!! Link to comment Share on other sites More sharing options...
marilynpac Posted May 18, 2010 Share Posted May 18, 2010 I've had ocular migraines and mine started unilateral and went bilateral. My first impression was meniers(sp) disease b/c members of my family have had that with almost the same sx that you describe. Also I've heard of people with hyperlipidemia experience this. Getting another consult is an excellent idea. Link to comment Share on other sites More sharing options...
ndaisyk Posted May 18, 2010 Author Share Posted May 18, 2010 Thank you for your response!!! Link to comment Share on other sites More sharing options...
jer_sd Posted May 18, 2010 Share Posted May 18, 2010 Off the top of my head Nystagmus can indicate vestibular dysfunction did you check Romberg? Link to comment Share on other sites More sharing options...
mjohnson3604 Posted August 23, 2010 Share Posted August 23, 2010 Hi, I have seen patients with sudden onset Nystagmus in practice as an Ophthalmic Technician. Many times there is a neurological underlying cause, but sometimes latent refractive error, trauma, an even stress can have same result. Make sure your consult is with a Neuro Ophthalmologist or Peds/Oculomotor specialist (they can at least relieve the dizzyness with prism or other methods). Good Luck Link to comment Share on other sites More sharing options...
bmurphyl512 Posted August 23, 2010 Share Posted August 23, 2010 Dizziness and tinnitus. How about acoustic nueroma? Just a pre-pa student stab at it. Link to comment Share on other sites More sharing options...
bradtPA Posted September 23, 2010 Share Posted September 23, 2010 You can try the Dix-Hallpike maneuver, and see if you get a response.... Link to comment Share on other sites More sharing options...
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