Another lady with dizziness

[JPINFV]

Assess visual fields. One eye at a time, check when she first sees a pen in her peripheral vision. I'm saying contusion of the left visual cortex for the win. What sort of workup did she have after the MVC?

[madmedic8522]

has her cancer returned and spread? was the Milrinone prescribed with the chemo 1.5 yrs ago?

I do apologize for not getting all the info yet, I'm trying to get some food before i get another call.

BTW Doc, LOL, no, i don't have one of those fancy CT scan things. LOL!

[ERDoc]

Assess visual fields. One eye at a time, check when she first sees a pen in her peripheral vision. I'm saying contusion of the left visual cortex for the win. What sort of workup did she have after the MVC?

Ahh! Education showing its ugly head. When you assess visual fields you find a left temporal hemianopsia. No cardiac history. Only history is breast ca and only PSH is the mastectomy. No drug abuse and only other med is milrinone (which is confirmed by looking at the bottle and checking the pills on poisendex).

[hammerpcp]

If I am reading this right she is having problems seeing to the right, the left and to the front. Is this constant or transient? Does she have any vision at all? I've never heard of Milrinone but a quick google said it has inotropic/vasodilatory effects, indicated for pt's wiht ventricular dysfunction. As previously stated this isn't consistent with a cyst unless there are other indications I am not aware of or this is some mysterious kind of cyst. Sounds like some involvement of the optic nerve or occipital lobe. She is also dizzy though, maybe we are looking at involvement of the vestibular or multiple cranial nerves. Where on her head was this original bump? Was it spontaneous, or trauma related? any associated symptoms? When did these vision problems start? before or after the MVC? perhaps this mvc was somehow due to her inability to see. :?:

[JPINFV]

Ahh! Education showing its ugly head. When you assess visual fields you find a left temporal hemianopsia. No cardiac history. Only history is breast ca and only PSH is the mastectomy. No drug abuse and only other med is milrinone (which is confirmed by looking at the bottle and checking the pills on poisendex).

Ok, I should have put right visual cortex off of the initial post (crazy little cross over those nerves do), but put it as left because of the problems that she has been having with the bushes recently.

Hx of cancer, so possible relapse with metastasis to someplace in the brain. Possible problems do to head injury.

[ERDoc]

So, it sounds like no one thinks this lady is crazy. You arrange for an intercept from that ambulance service with the really cool ambulances (does anyone know their name?) and now have whatever you want at the push of a button. Which buttons would you like to push?

[Punisher]

If she's got hemianopsia, my brain is going pituitary adenoma (I don't know why, but it sticks in my head) or a met or some other space occupying mass in that area....

Head CT

If nothing on the CT, angiography of the vertebrals

BMP (just to check everything)

ABG (I'm an RT, we order these on everyone j/k)

CBC (r/o infectious process)

ESR (r/o inflammatory processes)

PT/PTT/INR (rule out clotting disorders)

Biopsy of the lump on the back of her head ( yes, go wake up the path residents) j/k

[JPINFV]

I'll take an MRI for good measure besides the CT.

Also, you might want to start warming up the gamma knife...

[hammerpcp]

At this point I am going to have to go with good ol' BOB (Bed Oxygen Blanket), and transport. Maybe a cardiac monitor and blood glucose for good measure.

[ERDoc]

So, if someone can enlighten me as to how to post pics (jpgs), you may have some of your questions answered.