Medical Challenge Case #4

Case 4: The Dizzy Dame

S: Mrs. Jones is a 63 year-old woman who complains of dizziness and visual disturbances. This problem has persisted for about five years following a closed head injury sustained when a large metal lid of a garbage dumpster fell shut hitting her in the forehead causing her head to snap back and knocking her to the ground. She sustained momentary loss of consciousness. This problem did not appear to be present prior to her closed head injury. She states that whenever she holds her head in a certain position for any length of time, she begins to have problems with her eyesight and becomes dizzy. She also states that when she drives and has to turn her head in certain positions or hold it very long in one position she loses her ability to judge depth perception. 

O: Neuropsychological examination revealed some mild brain dysfunction involving visual discrimination, depth perception, spatial orientation, visual memory and other visual functions. Motor and tactile functions were all within normal limits as was neurological examination. She also exhibited mild signs of attention and concentration deficits as well as immediate memory and recall. She appeared to have had signs and symptoms of ADHD as a child. CT of brain showed early stages of ischemia. ECG was WNL. Cervical x-rays (shown here) show a reversal of her normal lordosis as well as degenerative and arthritic changes. Vascular testing of intervertebral artery demonstrated significant tortuosity however, patient suffered a small infarct in the brainstem during test so it was not completed.

A: What is your diagnosis of this patient?

P: What is your recommended plan of treatment?