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The dizzy patient
A 56-year-old man presents with a complaint of dizziness since yesterday. He notes a spinning sensation associated with nausea that lasts a few seconds. He is afraid to move his head because movement makes him feel ill. His past medical history is unremarkable. He takes multivitamins and does not smoke or use alcohol. He has no other symptoms.
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Epilepsy in older adults
Given that that the average person has one chronic illness for each decade over age 50, one would expect that patients who develop seizures in late life would have associated medical and/or neurologic conditions. Cerebrovascular disease, hypertension, heart disease, diabetes mellitus, renal disease, and dementia all relate to epilepsy. Co-morbidities not only contribute to the causation and consequences of seizures, they also interfere with effective treatment and optimal functioning. Because seizures in older individuals can lead to serious consequences, safe and effective treatment is essential. Yet, antiepileptic drugs (AEDs) may cause adverse effects that may be worse in older patients when compared to younger patients.
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CASE & COMMENT: What brought on these migraine headaches?
A 77-year-old woman arrives at the emergency department (ED) with family members who describe a sequence of excessive tearing in the left eye, followed 1 hour later by onset of a headache, and expressive aphasia shortly thereafter. She was brought to the ED within 30 minutes of the onset of aphasia symptoms. The patient is undergoing palliative chemotherapy treatment for metastatic adenomatous cancer of the sigmoid colon for the past 2 months, with a weekly regimen of fluorouracil and leucovorin, and had recently finished a course of localized pelvic irradiation for the large sigmoid tumor. A palliative diverting colostomy also had been performed.
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With new-onset nystagmus in adult, consider MS
Multiple sclerosis (MS) is associated with the development of various forms of nystagmus. The association is so strong that new-onset nystagmus in an adult should be considered MS until proven otherwise.
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