Brief Answer:
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Detailed Answer:
I read your question carefully and I understand your concern.

Medication like Compazine can have their share of side effects. I am not so sure I agree with using both Zofran and Compazine for what seems more of a chronic issue and the condition was stable judging from their description. Seems a somewhat aggressive approach. Zofran is more benign, however would wait a little with the situation being such as you describe it.

As for what it can be, nausea can have several different causes. Your primary care physician has recommended a neurological consult since neurological conditions can manifest with nausea. If no other cause is found brain imaging may be considered as well. However I do not think a neurological cause to be that likely. That is because in neurological conditions like, tumor, stroke, infections etc, usually nausea would be accompanied by other symptoms, at least with some headache. Since nausea has been present for 13 months it should be enough time for symptoms to progress, it's not a question of being in early stages. So you shouldn't be overworried about a brain lesion being the cause.

What should be considered before neurological conditions in my opinion is gastrointestinal issues. Issues such as gastroparesis, chronic intestinal pseudo-obstruction, irritable bowel syndrome, adhesions etc may manifest with nausea. For that reason imaging of digestive tract, usually done after ingestion of contrast may be considered, a gastroenterologist consult may be done as well.

Inner ear issues are another common cause of nausea. Usually they are accompanied by vertigo though, a sensation of spinning movement, so if that is not present it is unlikely.

One other possible factor I see on that report you have uploaded is high blood pressure. All the values measured are pretty high. High blood pressure may manifest with nausea, but usually there is some headache as well. Perhaps those values may be somewhat due to stress in that situation, but however they require more attention and some measurements in the following days are needed. If repeatedly high that should be evaluated and treated.

Metabolic alterations can cause nausea as well. However I see that you have had a metabolic panel in the ER, the results are not mentioned in the report but I suppose they would've been if any abnormality was noted. The only test I would add would be thyroid function tests as low thyroid function may lead to nausea.

One other possibility to be considered is also that of psychological factors, anxiety may manifest with all sorts of symptoms, nausea and light-headedness included. However that possibility should be considered only when other possibilities mentioned above have been excluded.

So for the moment I would give the given medication some time to be eliminated, at least 24 hours, do not get scared as it is not a threatening issue. Zofran may be tried carefully afterwards. In the meanwhile would speak to your doctor about the tests I mentioned, in particular gastrointestinal ones. The report says also that you are to return if there is no improvement in 2-3 days. I would do that, perhaps it can be a quicker way to be admitted and evaluated, since the prescribed medication didn't work. You can always refuse hasty injections if you feel that the tendency of the ER doctors is again of sending you off after applying a shot.

I remain at your disposal for other questions.

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Brief Answer:
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Detailed Answer:
Sorry for answering a little late when I am sure you must’ve been really anguished, but due to different time zones your follow-up question has happened to come just as I’ve gone to sleep.

Those eyeball movements you describe are called nystagmus. Among the possibilities I listed earlier such movements, with nausea and lightheadedness would indicate a vestibular issue, inner ear problem. In that case the most appropriate medication to alleviate them would be an antihistamine like dimenhydrinate or meclizine (over the counter medications also used for motion sickness). The trouble is that if she is unable to swallow anything she would need something by injection in the ER.

The other possibility would be that of a brain lesion in the brainstem, the abrupt aggravation would indicate stroke. I do not think it as likely though, usually there are other signs (headache, weakness or numbness of the face or limbs, slurred speech, trouble swallowing, movement coordination issues etc), so coupled with the young age it is not likely. However again if one wanted to probe further would have to go to ER as imaging would be the next diagnostic step when in doubt.

So if she still hasn’t improved in these hours since you’ve asked the follow-up question I would head back to the ER in order to get hydrated with iv fluids, and be re-evaluated for these movements and other neurological signs which might indicate a brain lesion. I know you do not like that but I think they will be more careful this time.

Let me know if I can further assist you.

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Brief Answer:
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Detailed Answer:
Thank you for the update!

It is good to know CT was normal, most brain issues have been excluded by that.

Vertigo is just a symptom, meaning sensation of spinning movement, often accompanied by nausea and vomiting. Inner ear issues are the most common cause, usually due to movement of free crystals in the inner ear labyrinths, called benign paroxysmal positional vertigo (BPPV), other causes like neuritis, infections etc being less common.
In terms of medication the antihistaminics which I mentioned (dimenhydrinate, meclizine) are the most used to alleviate the symptoms. As I said they are over the counter medications. In the case of BPPV there is also a sequence of movements called the Epley maneuver which can lead to major improvement. However in order to say whether that (BPPV) is the case and the affected side an ENT evaluation is necessary as observation of the nystagmus on certain head movements is key.

I hope to have been of help.

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Brief Answer:
Good luck!

Detailed Answer:
I hope she'll feel better soon. I have had many patients with inner ear issues as well as having suffered a bout myself for the first month of this year, so I know how awful it is.

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