Open AccessNeurological examination as an impressive factor in the dizziness assessment
Author(s) -
Carlos Eduardo Dilen da Silva,
Allan Rubens Zucolloto,
Bianca Castoldi Scuassante,
Luciano Stefanato Negrini
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.321
Subject(s) - ophthalmoparesis , medicine , neurological examination , neuromyelitis optica , brainstem , nystagmus , vertigo , physical examination , context (archaeology) , internuclear ophthalmoplegia , diplopia , magnetic resonance imaging , radiology , surgery , multiple sclerosis , ptosis , paleontology , psychiatry , biology
Context: Dizziness or vertigo is a very common clinical manifestation, usually of labyrinthic origin. However, an accurated neurological clinical examination is crucial for the diagnosis of central origin. Case report: D.F.A, 40 years old, female, white, Brazilian. She has been reportining of intense dizziness for a few months and relevant postural instability. She reports two previous hospitalizations, without a closed diagnosis, and is then referred to the specialist. On clinical examination, she had bilateral internuclear ophthalmoparesis and bidirectional nystagmus in her right eye. Requested magnetic resonance imaging (MRI) of the skull suggestive of demyelinating lesions in the wall of the fourth ventricle, pons and, especially, in transition between medulla oblongata and spinal cord, compatible with Neuromyelitis Optica (NMO) with manifestations of trunk syndrome. After pulse therapy, she obtained a good clinical evolution, with the maintenance of sensory deficits as a result of the injury, but with significant improvement in bilateral ophthalmoparesis and balance. Some studies already report brainstem involvement in patients with NMO, describing the presence of brainstem´s signals. Conclusion: In the case in question, therefore, the patient remained for almost two months without an accurate diagnosis, being the neurological examination the crucial factor for the suggestion of a disease of central origin, reporting a case of onset NMO with of brainstem´s signals.