![]() ![]() The causes of vertigo are many the common denominator is an abnormality in the vestibular system, which comprises the inner ear labyrinth and the central nervous system (CNS) structures that process signals from the labyrinth. Vertigo is an illusory sensation of motion, of self or surroundings, and can be rotational (ie, a spinning sensation) or translational (ie, a sense of floating upward). A subsequent review of the case indicated that the death was potentially avoidable, had life-saving neurosurgery been performed within the first few hours of her ED presentation. ![]() An hour later, the patient sustained a cardiopulmonary arrest and could not be resuscitated.Īutopsy revealed that the patient had died of a cerebellar hemorrhage. At 11:00 PM, the patient complained of a headache and was given acetaminophen 650 mg by mouth. At that point (10:00 PM), the physician decided to hold her overnight in the ED and admit her if she was not better in the morning. ![]() Four hours later, she was signed out to a third attending. An hour after that, the patient was signed out to a second attending, who administered atropine 0.5 mg IV. An hour later, however, the patient noted little improvement, and so lorazepam 2 mg IV was given. A provisional diagnosis of labyrinthitis was made, and prochlorperazine (Compazine) 10 mg IV was administered. Neurological exam was grossly normal-the patient could follow commands and there was no focal weakness. Physical examination was limited because the patient's vertigo dramatically worsened when she opened her eyes. Her initial blood pressure in the emergency department (ED) was 170/90 (at about 4:00 PM). A 64-year-old woman, with no prior medical history, complained of sudden onset of severe vertigo and vomiting, without headache. ![]()
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