Ex butcher worker

Admitted on 29/12/23

Ex butcher worker

Referred by GP for 1/52 ongoing dizziness, leaning to left side. unsteady gait, intermittent frontal headache. pmhx - T2DM, HTN. patent speaking freely pwd appears well-looking walked into triage

72M progressive gait instability over one week, recently commenced on perindopril# Gait disturbance/disequlibirum FI ? stroke- Sx: dizzy/gait disturbance without vertigo or hearing changes- Ex: no cerebellar sign, UL/LL/CN exam NAD, however Gait: wide base, short stride length, multiple steps to turn, unable to walk heel to toe; Rhomber's positive- CT-B/A: No evidence of established infarct, noting that acute ischaemia can be occult on CT. No high-grade stenosis involving the carotid or vertebrobasilar arteries. No intracranial large vessel occlusion, aneurism or large high-grade stenosis.- HbA1c 5.8%- Total chol 6.4 - commenced on atorvastatin 80 mg on admission# L semicircular canal dehiscence- CT 29/12: Dehiscent arcuate eminence overlying the left superior semicircular canalProgress review- bowel not opened since admission- obs wnl, stable- no medical concern from nursing note- ECG so far was SR- No significant postural drop so farImp: potential posterior circulation stroke. Currently clinically stable

Stroke CWR - Da Cruz (reg) , Lai (hmo), Jamriska (intern), Bergqvist (stroke CNC)72M progressive gait instability over one week, recently commenced on perindopril# Gait disturbance/disequlibirum FI ? stroke- Sx: dizzy/gait disturbance without vertigo or hearing changes- Ex: no cerebellar sign, UL/LL/CN exam NAD, however Gait: wide base, short stride length, multiple steps to turn, unable to walk heel to toe; Rhomber's positive- CT-B/A: No evidence of established infarct, noting that acute ischaemia can be occult on CT. No high-grade stenosis involving the carotid or vertebrobasilar arteries. No intracranial large vessel occlusion, aneurism or large high-grade stenosis.- HbA1c 5.8%- Total chol 6.4 - commenced on atorvastatin 80 mg on admission- No postural drop inpatient# L semicircular canal dehiscence- CT 29/12: Dehiscent arcuate eminence overlying the left superior semicircular canalProgress review- Patient feels well, no issue- Bowel opened today- Felt that walking now is not as dizzy, only a very small bit - much improved> completely fine on bed> head turning does not trigger vertigo- Eating and drinking fineO/ETemperature 36.2 (07:41)Systolic Blood Pressure 132 (07:41)Diastolic Blood Pressure 79 (07:41)Pulse 67 (07:41)SpO2 97 (07:41)Respiratory Rate 18 (07:41)Imp: potential posterior circulation stroke. Currently clinically stablePlan:IP MRI ? infarct ? dehiscence of semicircular canal (will talk to ENT post this if required)Encourage smoking cessation - PRN patch chartedAH reviewPT please to Dix HallpikeBowel chart and PRN aperientNo driving but duration depends on MRI finding

# L semicircular canal dehiscence- CT 29/12: Dehiscent arcuate eminence overlying the left superior semicircular canalProgress review- bowel not opened since admission- obs wnl, stable- no medical concern from nursing note- ECG so far was SR- No significant postural drop so farImp: potential posterior circulation stroke. Currently clinically stablePlan:IP MRI ? infarct ? dehiscence of semicircular canal (will talk to ENT post this if required) - to be protocolled in hoursEncourage smoking cessation - PRN patch charted

Stroke AdmissionHMO L NuttonDelay in admission completion due to clinical acuityPC:72M progressive gait instability over one weekRecently commenced on perindoprilCTB - L semicircular canal dehiscenceHOPC:- 1 week of progressive gait instability- Was sitting down last Friday in the sun, felt unsteady and thought had 'sunstroke', felt pressure in middle of forehead suddenly- Has noted since then unsteadiness when walking - staggering/walking to left side- No sensation of room spinning- Premorbidly nil mobility issues.- No change to speech- Denies difficulty swallowing- No reported subjective neurology beyond small patch of lip numbness; feeling 'warm' down outer aspect of R leg- No trauma / injury- Systemically well, no fevers, no vomiting- Went to GP and was given prochlorperazine + perindopril - felt made swaying to L symptoms worse- No hearing loss or tinnitus R or L- While in ward 3E has mobilised to toilet and feels symptoms of swaying have improved, able to mobilise well PMHx:HypertensionMeds:Perindopril 10mg dailyProchlorperazine 5mg TDSSHx:iADLsSmoker - 10-15 per dayNo regular alcoholNo recreational drug useRetired butcherO/E:Temperature 36.2 (00:25)Systolic Blood Pressure 165 (00:25)Diastolic Blood Pressure 78 (00:25)Pulse 75 (00:25)SpO2 97 (00:25)Respiratory Rate 18 (00:25)ED examination:A - PatentB - Sats / RR normal RAC - Haemodynamically stable; sys 160GCS 15Wide based gait; favouring L sideCannot heel toeRomberg's negative but some swaying; feels unsteadyNo PP / DDKSpeech normalSeen at 05:00 and re-examined:Looks wellChest clear, good air entry bilaterallyHS DNMPEARL, eye movements normalSpeech normalFacial movements normalPower 5/5 U+L limbsSensation normalCoordination normalLying in bed and sleepy so not mobilisedDenies any vertigo/dizziness lying down/sat upIx:Bloods - NAD, normal inflammatory markersCT B/angiogram:No evidence of established infarct, noting that acute ischaemia can be occult on CT.No high-grade stenosis involving the carotid or vertebrobasilar arteries. No intracranial large vessel occlusion, aneurism or large high-grade stenosis.Left-sided semicircular canal dehiscence. ENT referral suggested.CT Temporal bones:Dehiscent arcuate eminence overlying the left superior semicircular canal. This can be an incidental finding however, in the correct clinical setting this may relate to superior semicircular canal dehiscence syndrome. Clinical correlation is essential.

AH reviewPostural BP for 1 more dayECG TDS as per stroke pathwayNo driving but duration depends on MRI finding

Medications:

Amlodipine 5mg

Aspirin 100mg

Atorvastatin 80mg

Clopidogrel 75mg

Enoxaparin 40mg

PRN

Nicotine patch 21mg transdermal

Paracetamol 1000mg

Prochlorperazine 5mg TDS

Diet

Diabetic diet

ment Type:CT IAMsDocument Date:29 Dec, 2023 20:16 AEDTDocument Status:Auth (Verified)Document Title/Subject:Temporal Bones/IAM (+/-Brain) C- (CT)Performed By/Author:gordonra -GORDON, Rachel on 29 Dec, 2023 20:16 AEDTVerified By:gordonra -GORDON, Rachel on 29 Dec, 2023 20:16 AEDTVisit info:30317073, Sunshine, Inpatient, 29/12/2023 - Contributor system:WH_RAD

Result:-

* Final Report *

MI IMAGE LINK

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Temporal Bones/IAM (+/-Brain) C- (CT) (Verified)

REPORTEXAM: Temporal Bones/IAM (+/-Brain) C- (CT)CLINICAL NOTES:72-year-old male with 1 week of progressive gait instability. History of hypotension.? Semicircular canal dehiscenceTECHNIQUE:CT petrous temporal bones (re-formatted form CT brain performed earlier today at 1:07 p.m.) with Poschl and Stenver projections.FINDINGS:Dehiscence of the arcuate eminence overlying the left superior semicircular canal. No mastoid or middle ear effusion.The left posterior and lateral semicircular canals are well covered.The right semicircular canals are intact.No middle ear or mastoid effusion.CONCLUSION:Dehiscent arcuate eminence overlying the left superior semicircular canal. This can be an incidental finding however, in the correct clinical setting this may relate to superior semicircular canal dehiscence syndrome. Clinical correlation is essential.Reported and electronically signed by: Rachel GORDON - Radiology Registrar at 22:12 29/12/2023