Wednesday, January 12, 2005

The Internet, the wrong kind of vertigo and Hickam's Dictum

A vignette in which Hickam's Dictum trumps Occam's Razor as a patient labeled as having Meniere's Disease discovers-thanks to Google- she really had a different kind of vertigo.
A 43 year old lady developed aural fullness, tinnitus and unilateral hearing loss and is told she had 2 of the 3 criteria for the diagnosis of Meniere's Disease. Within a few weeks she developed vertigo ( now she had the third symptom) which was precipitated by head movement and lasted only a few minutes. Researching her condition on the web she learned that the typical vertigo of Meniere is episodic and may last from hours to days and the type of vertigo she experienced seemed more like that described as BPPV. She told an audiologist of the symptoms and was treated with the Eply manuever. She had been free of vertigo since that time.
Even though she had the classic triad of Meniere's she may have actually had Meniere's without vertigo-people write of such an entity- plus BPPV.
Had she not researched her condition no one might have tried the otolith repositioning manuever.
Hickam ( if there really was such a person) purportedly said " A patient can have as many diagnoses as he darn well wants", Occam's Razor notwithstanding. ( Hickam's contribution to medical diagnostic lore is a bit obscure-I only got two relevant hits on a Google search on 1/12/05)

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