question-icon

Varicose leg ulcer, arthritis in knee, dizziness. Causes and treatment ?

default
Posted on Sat, 29 Sep 2012
Question: Hello, I have an 83yr mother, 40mg sotalol, varicose leg ulcer, arthritis in left knee (not elsewhere). On Tue at 5am she complained of dizziness when getting up. Emergency doctor called out. No heart murmour or a-fib, blood pressure ok 80/40, no strength issues, no co-ordination issues, no speech or facial issue, absolutely nothing else. Perfectly happy & lucid.
Put on 3mg procholorperazine.
Tue, no dizziness laid in bed.
Wed, can sit up ok in bed without dizziness.
Thu, can hang legs over edge of bed ok without dizziness.
Fri, moving a pillow suddenly causing her head to XXXXXXX caused the room to spin briefly, can hang legs over edge of bed ok without dizziness. BUT trying to stand resulted in dizziness.

Does have tinnitus and chronic history of sinus problems, snores a lot.
No eye motion, no change in hearing, eyesight fine, co-ordination fine.
Doctor has put her on 5mg (3x a day) prochloroparazene.

Is this a viral thing (doctor says "maybe" and audibly non-committal) or is it a cerebellum stroke?

What do I do about keeping her from getting bed pressure sores?
Oh, she did not have any dizziness without head motion if that means anything.
Not able to stand up as of Fri evening (not tried, but it is unlikely following the attempt earlier today).
Thanks.
doctor
Answered by Dr. Sumit Bhatti (2 hours later)
Dear XXXXXXX

Thank you for your query.

1. Prochlorperazine may be causing her dizziness. It can cause orthostatic or postural hypotension - low blood pressure on standing up. This needs to be considered as her dizziness disappeared and then came back again.

2. Prochlorperazine is also preferably to be avoided when on anti-arrhythmics such as sotalol.
You may discuss with your physician and perhaps to change to 'cinnarizine' or 'betahistine', if the dizziness persists.

3. A cerebellar stroke will have a multitude of cerebellar signs such as unsteady gait (ataxia), intention tremor, past-pointing, dysdiadochokinesis (inability to rapidly flip the hands), upbeat or downbeat nystagmus. In the absence of the following signs, it's less likely to be a cerebellar stroke.

4. The chances of bed sores can be reduced by frequent change of position. Alternatively you may request for a water bed to reduce the chances of bed sores. Meticulous nursing care can prevent or delay the formation of bed sores.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.

Regards


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Sumit Bhatti (15 hours later)
She remains in bed, it is a super-foam soft dunlopillo,
which gives even pressure but tends to be very bouncy!!

Re 1, Prochlorperazine,
- Dizziness not continuous at any point.
- Dizziness occurs when trying to stand, from TUE-SAT.
- Dizziness occurs if sudden head jerk

Re 2) noted.

Re 3)
- can not assess gait as unable to stand.
- zero intention tremor
- zero past pointing issues
- zero difficultly tapping fingers or flipping hands
- zero nystagmus up or down when told to focus on a point
- bright, alert, co-ordinated, high visual acuity, just dizziness only on standing

Re 4) noted.

Chronic catargh, sinuses blocked across top of forehead & under
eyes, voice hoarse, tinnitus in right ear, some ear clicking.

A virus was mentioned - but would that last from TUE to SAT+?
Particularly no dizziness except when standing or rolling rapidly across
the bouncy bed (either of which cause room to spin a bit for a few secs).

There is the chance it could be a virus, but would that last TUE-SAT+?
I had something similar, first 2 coughs, then sore throat, then extremely
brief (<1sec) dizziness the same day & again very occasionally since.

Doc will be telephoned next THU if still unable to stand (or at
least get from the bed to a proper chair commode I got for her).
doctor
Answered by Dr. Sumit Bhatti (2 hours later)
Dear XXXXXXX

Thank you for your reply.

1. Viral labyrinthitis or Vestibular Neuronitis is usually a retrospective diagnosis for dizziness when all other causes are ruled out. If her dizziness subsides, it probably was related to a viral infection.

2. She does not have any cerebellar signs.

3. Common causes for dizziness in her case (which will have to be ruled out by your physician) would be:
a) BPPV (Benign Paroxysmal Positional Vertigo) since her dizziness occurs on change of position.
b) Cervical Spondylosis, since jerky head movement causes dizziness.
c) Drug induced and othrostatic hypotension on standing up.
d) In Labyrinthitis, hearing is also affected. In Vestibular Neuronitis, only balance is affected. Get an PTA (Pure Tone Audiogram) done, as she has tinnitus.
e) If chronic catarrh and sinusitis causes changes in middle ear pressures, it may cause dizziness. This can be picked up by Impedance Audiometry (I/A).

Hope this answers your query.

Wish your mother a speedy recovery.

Regards.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
Answered by
Dr.
Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2658 Questions

premium_optimized

The User accepted the expert's answer

Share on
Varicose leg ulcer, arthritis in knee, dizziness. Causes and treatment ?

Dear XXXXXXX

Thank you for your query.

1. Prochlorperazine may be causing her dizziness. It can cause orthostatic or postural hypotension - low blood pressure on standing up. This needs to be considered as her dizziness disappeared and then came back again.

2. Prochlorperazine is also preferably to be avoided when on anti-arrhythmics such as sotalol.
You may discuss with your physician and perhaps to change to 'cinnarizine' or 'betahistine', if the dizziness persists.

3. A cerebellar stroke will have a multitude of cerebellar signs such as unsteady gait (ataxia), intention tremor, past-pointing, dysdiadochokinesis (inability to rapidly flip the hands), upbeat or downbeat nystagmus. In the absence of the following signs, it's less likely to be a cerebellar stroke.

4. The chances of bed sores can be reduced by frequent change of position. Alternatively you may request for a water bed to reduce the chances of bed sores. Meticulous nursing care can prevent or delay the formation of bed sores.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.

Regards