[63F] With severe nausea, dizziness, and vision changes

Patient Description

A 63-year-old female presents with a seven-month history of severe nausea, dizziness, fatigue, and weakness, particularly in the arms. The nausea, rated 7/10 in severity, is exacerbated by watching TV or using a computer but is partially relieved by Lorazepam and Ondansetron. The dizziness, described as a feeling of floating and insecurity, is rated 8/10 in severity. The patient also reports severe weakness in the arms, making it difficult to perform household tasks, and has a history of a neck injury. Additionally, there are significant vision changes, including double and blurred vision, rated 9/10 in severity. The patient has a long-standing diagnosis of hypothyroidism, managed with Plaquenil (200mg) and Synthroid (125mcg), and takes Ondansetron (4mg) and Lorazepam (5mg) as needed. No known allergies or other medications are reported.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, the following conditions may be considered:

  • Vestibular disorder: This condition affects the inner ear and balance, leading to symptoms like dizziness, a floating sensation, and nausea. It can also cause fatigue and problems with concentration and memory.

    • Testing for this condition usually involves a physical examination, hearing tests, balance tests, and possibly imaging studies like an MRI.
    • Treatment typically involves physical therapy, medication, and in some cases, surgery.
  • Thyroid disease: Given your history of hypothyroidism, it's possible that your symptoms are related to your thyroid condition. Hypothyroidism can cause fatigue, weakness, and sometimes dizziness.

    • Regular monitoring of your thyroid hormone levels is important to ensure your medication dose is appropriate.
    • Treatment involves taking thyroid hormone replacement medication, like the Synthroid you're currently taking.
  • Neurological conditions: Some neurological conditions, such as Multiple Sclerosis or a brain tumor, could potentially cause the symptoms you're experiencing.

    • These conditions would typically be diagnosed through a combination of physical examination, imaging studies, and possibly a lumbar puncture.
    • Treatment varies widely depending on the specific condition and its severity.
  • Medication side effects: Some of your symptoms could potentially be side effects of the medications you're taking.

    • If this is the case, your doctor may recommend adjusting your medication regimen.

What you can do

Given the severity and duration of your symptoms, it's important to seek medical attention as soon as possible. Here are some steps you can take:

  1. Schedule an appointment with your primary care doctor. They can perform a physical examination and order appropriate tests.
  2. Keep a symptom diary. This can help your doctor identify any patterns or triggers related to your symptoms.
  3. Stay hydrated and maintain a balanced diet. This can help manage your symptoms and support your overall health.

What you should look out for

Please seek immediate medical attention if you experience any of the following:

  • Sudden, severe headache
  • Difficulty speaking or understanding speech
  • Sudden numbness or weakness, especially on one side of the body
  • Sudden loss of balance or coordination
  • Sudden, severe vision changes

Please remember that while I strive to provide accurate information, I'm an AI and not a substitute for professional medical advice. Always consult with a healthcare provider for a formal diagnosis and treatment.

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11 mo ago

People Also Ask


What are common symptoms of a vestibular disorder?

Common symptoms of a vestibular disorder include dizziness, a sensation of spinning or floating, balance problems, nausea, and sometimes hearing changes. These symptoms can affect daily activities and may require medical evaluation and treatment.


How can hypothyroidism affect my overall health?

Hypothyroidism can lead to symptoms such as fatigue, weight gain, cold intolerance, dry skin, hair loss, and muscle weakness. It is important to manage it with appropriate medication to maintain normal thyroid hormone levels and prevent complications.


What are potential side effects of taking Lorazepam and Ondansetron?

Lorazepam can cause side effects like drowsiness, dizziness, tiredness, blurred vision, and unsteadiness. Ondansetron may cause headaches, dizziness, constipation, or fatigue. It's important to discuss any side effects with your doctor.


What are the signs that I should seek immediate medical attention for my symptoms?

You should seek immediate medical attention if you experience sudden, severe headache, difficulty speaking or understanding speech, sudden numbness or weakness on one side of the body, sudden loss of balance or coordination, or sudden, severe vision changes.


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