Case Study on Benign Paroxysmal Positional Vertigo, Cervical Spondylitis with Bilateral Carpel Tunnel Syndrome and Psychosis under Evaluation

Abstract

A 55-year-old female patient was admitted in the general medicine female ward with the chief complaints of giddiness for three days, headache for three–four days (increases during exposure to light, sound and stress). She also complaints about nausea, vomiting on and off, giddiness on lying down and bending down, neck stiffness and pain in the both upper limbs for 5 years. Based on the subjective data’s obtained the prognosis was vestibular migraine, vertebra basilar insufficiency and psychosis under evaluation. Then the patient was referred to an ENT surgeon, orthopedician and a psychiatrist for further evaluation. Diagnosis of the disease was done by using barbeque roll test for left side and Dix–Hallpike maneuver test; both the test shows positive results for left lateral canal benign paroxysmal positional vertigo (BPPV). Thus, it was concluded that the patient is suffering from left lateral canal BPPV (benign paroxysmal positional vertigo). Also, the patient complaints about cervical spine tenderness and numbness of both hands, orthopedician examined and has diagnosed that the patient is suffering from cervical spondylitis with myofasciitis with bilateral carpal tunnel syndrome. During psychiatry examination, the patient complaints about low mood, anger, irritation, crying spells, talking self, suicidal ideation, delusion of persecution and the impression was under observation to rule out psychosis. The patient was treated with tablet Stugeron (Cinnarizine) and tablet Betavert(betahistine) for benign paroxysmal positional vertigo, alsotablet Nervijen P (combination of Methylcobalamin, Pregabalin, Folic acid Benfotiamine,vitamin B6) andtablet Rabemac DSR (combination of Rabeprazole and domperidone) was administered. Orthopedician advicetablet Zix MR (combination of aceclofenac and thiocolchicoside), Ointment. Powergel (Diclofenac) for topical application and tablet. Calcimax (combination of elemental calcium, vitamin D3, selenium, magnesium, lysine and zinc) for cervical spondylitis and bilateral carpal tunnel syndrome. As the patient was under evaluation to rule out psychosis, the psychiatrist has advised tablet. Petril MD (clonazepam). In this case, it is understood that the patient is suffering from comorbid conditions hence a much care should be taken while prescribing the drugs because the chances of drug–drug interactions are very high, and also a good counselling session must be given to both the patient and the care givers about the disease conditions, about the medication (dose, frequency, indication, side effects, etc.) and about the lifestyle modification. A proper and well-maintained lifestyle modification and a good adherence to medications will improve the quality of life of the patient. It will help to reduce the signs and symptom and also prevents worsening of the disease.

Keywords: Giddiness, BPPV, psychosis, neck stiffness, cervical spondylitis

Cite this Article

Karthika Roop. Case Study on Benign Paroxysmal Positional Vertigo, Cervical Spondylitis with Bilateral Carpel Tunnel Syndrome and Psychosis Under Evaluation. Research & Reviews: A Journal of Neuroscience. 2020; 10(1): 20–24p.