Disclosures: Anusha Lekshminarayanan, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 52-year-old male presented with dizziness following left medullary stroke.

Case Description: A 52-year-old male with history of hypertension and hyperlipidemia presented with severe dizziness, nausea and vomiting, leg weakness leading to a fall with brief loss of consciousness. Initial CT head and CT cervical spine were negative. He sustained bilateral minimally displaced sacral wing fractures requiring no surgical intervention. Orthopedics recommended weight bearing as tolerated for right leg and toe touch weight bearing left leg. Pain control was achieved with acetaminophen and tramadol as needed (tapered off). The patient’s dizziness did not improve with IV hydration. MRI head obtained for persistent dizziness revealed an acute infarct in the left medulla and right periventricular white matter, and chronic infarcts in the cerebellum, brainstem, corona radiata, thalamus and basal ganglia. Aspirin and atorvastatin were given for secondary stroke prophylaxis.

Setting: Acute inpatient rehabilitationAssessment/

Results: On admission to acute inpatient rehabilitation (AIR), the patient complained of severe dizziness not affected by position, strength was 5/5 on the right side and 4/5 on the left. Cranial nerves and light touch were intact. On initial PT and OT evaluation and 2 days after, the patient refused to attempt standing due to dizziness. On day 3 (AIRD3), olanzapine 2.5mg PO daily and meclizine 50mg PO BID was initiated. Dizziness improved significantly. The next day, he ambulated 20’; AIRD7 he performed stair training. At discharge (AIRD18), he was asymptomatic, ambulated 350′, 12 stairs.

Discussion: Central vertigo is notoriously difficult to treat. Low-dose olanzapine and meclizine were extremely effective in alleviating our patient’s symptoms and permitting leading to significant functional gains. Meclizine alone had not previously been beneficial, however, this or a non-specific placebo or time since stroke cannot be ruled out as the cause of improvement.

Conclusion: Further study of olanzapine with or without meclizine for central vertigo may be warranted.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/low-dose-olanzapine-and-meclizine-as-treatment-for-disabling-dizziness-in-medullary-stroke/