Level 1: Dizziness – Contrasting Case #1: Patient Information

Given these changes from the original case, what is your diagnosis?

What is your diagnostic explanation?

As compared to the long case, this patient is a 65 year old man whose symptoms he describes as light headedness.

HPI: Episodes started this morning upon waking. When getting out of bed, he became very dizzy and fell to the ground. He does not know if he lost consciousness, but his wife saw the event and said there was no traumatic injury or convulsions and the patient sat up immediately after falling. There was no period of confusion after the event. He does recall a tunneling of vision, sweating and a racing heart before he became dizzy. After he fell down, the dizziness subsided. Yesterday afternoon, his family ate at a new restaurant and all of them developed diarrhea and nausea. The patient’s diarrhea resolved later in the evening but he felt nauseous until he went to bed.

PMH: No prior heart disease or congenital illness. Erectile dysfunction treated with Viagra. He struggles to maintain blood sugars in the desired range because he runs a local bakery and loves Turkish delight.

PE: Blood pressure 130/82 while laying flat, but drops to 102/60 when standing and is associated with the symptoms of dizziness. Cardiovascular exam shows a regular tachycardia with a rate of 105 bpm and a regular rhythm with no murmurs/gallops/rubs/clicks. Neurologic exam reveals decreased sensation on the plantar surface between the 1st and 2nd tarsals and no other gross deficits.

Labs: HbgA1c is 9.5, Hemoglobin of 12.4 mg/dl and HCT of 46%, CMP shows a Na+ level of 148 and no other abnormalities