Next patient is harrison b l b a l e 735694 25 year old man investigation crp 1 hemoglobin a 157 eosin is normal lfts normal bolate normal b12 normal calcium normal phosphate normal magnesium normal tsh tested in december and that was normal reviewing the gp record baste out throughout the day concentrate struggling to concentrate wet because his vision is blurry he's had his eyes tested and they're apparently normal sit on the scales I'm rob I'm 1 of the medical registrars only doctor that was looking after you was telling me all about it and I read a bit of your gp records that you've been feeling just weird is that right since october and what's the number 1 thing for you is it the dizziness or is it the nothing else that you do it's the dizziness the dizziness yeah because that obviously sets everything up and up and describe the dizziness to me it's like just like struggling to focus all the time and it's like insisted it was a balance of guilt just out of it mhmm like about a couple of pints all the time mhmm it's really weird like you're off kilter yeah okay okay do you feel like the room spins around you not so much spinning no it's more just like almost like a boat mhmm I feel like more like you just can't get steady yeah I don't feel sharp till I feel good too yeah alright sorry about that you had a scan of your head which looked fine yeah and the radiologist looked at and it's totally fine there's nothing worrying there that we can see on your head scan it's obviously good it's a it's a very good scan if you look at your head but sometimes so how what did the a how much did the a and e doctor explain to you about the tests they were doing and things like that then wasn't it not not nurses so when people have dizziness and symptoms like this we think there can be problems with the ear that can cause dizziness and feeling like you're on a boat and there can be problems in the brain that cause those things we scanned your head with a ct scan and it looked fine so there's nothing big in your brain causing it but the tests that he did make it look like there's something in your brain as a cause of the dizziness as opposed to your inner ear or your middle ear our tests are imperfect so the pressure skew seeing how your eyes move the impulse the head impulse test all those things that you did with you they suggest that there may be something central going on in the cause for it I e something in the brain but as I say it's imperfect and it's off and wrong given that I suggest we have a look at your head with a different type of scan probably I would suggest doing an mri scan of your head and we've got a special protocol for how we can get these mri scans relatively quickly and often we're worried about essentially course I think the thing that we're worried about is having a very tiny stroke and it would be incredibly uncommon for someone of your age to have a tiny stroke but sometimes things weird things do happen because it's not unusual and that's what we're hoping to exclude with the test so I'll chat to the radiologist who's the expert in looking at the pictures look at your ct head scan again and make sure that they're happy to do an mri scan of your head if they are we could get you back for that probably tomorrow you could come home and then come back through our acute medical unit have the mri scan and we could get them to the doctor same day that would be the ideal thing to do and we'd be able to reassure you that there's nothing central going on it would be weird to have the constellation of symptoms that you have so not just the dizziness people who've had a stroke will say it feels like I'm really the room's spinning around me and I'm on a ship the whole time but they won't tell me that they feel glazed over and they feel that they can't concentrate and things like that so I'll add on lots of blood testing for weird and wonderful alternative causes of systemically feeling but hopefully we can find out if there's anything else going constantly tired and around now obviously looks knackered and that lot he's electricians goes up on rudders and he's up sometimes it's very boring and life at me at the minute because he's felt like shit since october yeah because we need we wanna get down to the bottom of it to be fair yeah yeah just a yeah all your blood tests are plum normal which is good and you've and ben's done a great panel of blood tests for you I'll add on a few more weird and wonderful but I I doubt very much they're gonna show anything but agreed it's all very strange yeah it is strange and what's changed in your life since october nothing because you moved out in july so it's not even nothing such that happened in still got the same job still living in the same place you moved out in july you moved in somewhere on your own mhmm yeah I was moved in by then yeah same nature happened in is it a house or a flat or flats mhmm in torquay in brixham in brixham lovely and you literally whereabouts in brixham 5 minutes down the road like on parkside so it's like part time brixham mhmm yeah lovely yeah everything's fine it's just strange just feel so hot and drained out of the way we've tried tyranoid as much as we can now because the gps have been useless yeah and rarely people tell me their gp is good I think they're overwhelmed yeah and I keep saying so we need consult here do another consult keep on consulting more like not knowing what it is that infuriates me it's not like an easy thing to just go I'll start you know what I mean to try and track it down especially now that my blood is dying because you were we were trying to play more with it an inner ear infection or something like that and I came back as well as like she would say that it's an infection it would come back and it's like sometimes you can have things that aren't infections in the inner ear people have problems with stones in the inner ear that you know and things like that that wouldn't necessarily be an infection but like I say the head impulse test that we did makes it look like it's a central cause as opposed to an ear cause which is why we're pursuing that mri scan but if the mri scan's plum normal then I think seeing the ear nose and throat teeth would be the right thing to do to look for whether there's any cause there making you feel quite better other than that you're burning out of sore bottom you know yeah yeah sorry I've got a lot of medical issues I keep saying too oh can't be this it can't be that because it's not the same line as do you mind me asking what medical issue you're thank you hereditary alpha tryptophan yeah alpha tryptophan 1 antitrypsin mhmm and I'm I'm diabetic I'm asthmatic k there's loads of genetic yeah arthritis thyroid problems mhmm so I tick all the what if you can get it things and oh yeah so if you're gonna get it my baby's got it mhmm so I tick all the boxes so I'm like going to him but trying to see whether he go the same way yeah we checked a lot of things did yeah so yeah I think he's all got the diabetic and yeah that lot so yeah did you share your memories again right no had a massive car crash back in head very really yeah he's been a fan and lantern in the back or and the side inside and where he was awful yeah so and his memory from there has been people have a post concussion syndrome that can last years sometimes yeah but this has been just completely different yeah is different I don't know what what you call it like I said it was just like october time do ever get palpitations or anything like that not really but it's like sometimes some days it's worse mhmm and other days it's not so bad I almost the next day it's so strange it's like mhmm you had a different bad day friday yeah did yeah I had like a headache and stuff and it just stopped does it ever come with a headache sometimes it does but not every time not every time no it's very and you say it kinda comes and goes does it ever go away no or does he just not notice it you've not got to the stage now where like you just look abnormal yeah yeah abnormal which is a problem and then I'll have days where I don't mention it but I'm I feel like it's always there but I think if I'm busy then I don't notice it mhmm do you know what I mean like I get real busy at work I just go into this sort of thing like oh that's a bad yeah so I mean when I start by the end of day I'm like okay yeah but I think you've got so useful it's me and me and you go no I've not I've had a bad day today it affect your coordination at all when you're at work say for example you're don't know a little bit like fiddling getting wired through something yeah yeah when I go on a pair of steps sometimes I feel a bit backwards rather you feel like you might fall off yeah I'm saying have you ever done that no I've fallen off step others for other really been to bed no not I'm not from there no okay good yeah fine like I said I just feel like off balance then sometimes I'll be anxious I've had an eye test yeah and I've got 20 20 vision so vision looks like you know go to the scanner mhmm but that's not all the time it's 1 of the variables mhmm gonna have a look at you is that alright just so you don't take anything off just just just just thinking and thinking and turning your head over for me you've done some work with these herbs good analysis yeah it's not really difficult so I'm just gonna put this down the front just pop down here good and then just do some tests did did they test all the are you yeah they they did didn't they he moved his finger around up and down then that's what worried him is when he was like going back and forth he'd done that quite a can we do a few things like that again is that okay yeah can you read my badge from this right from this kind of range is that okay that's absolutely absolutely fine fine you can you can read read that that okay I'll read that fine that looks fine okay any change to your body's smell no just look at your finger turn over the room for me you wanna do it with my finger lovely back at the corner of the room for me and at my finger again that's fine okay let's test the fields in your vision just pop your right hand your right eye can you see my finger here keep looking at my face can you see my finger in the keep looking at my face can you see my finger in the corner of your vision yeah lovely keep looking at me yeah and any bits of your vision missing no lovely swap sides for me no any vision missing no no fine alright good I'm gonna take a look at the back of your where your reflexes from your eyes lovely then once again so just remind my finger trying to be at rest still it's just to be extreme I know it's uncomfortable extreme position sorry weight loss at all or any weight gain no I wouldn't say fluctuates a little bit but it's not like it's more close to what I'm doing do a bit of running so mhmm I tend to lose weight there but yeah nothing nothing drastic no feel me touching your face here here and here yeah right rise up for me look surprised that's great scrunch your eyes open them that's great lower your cheeks can you fix that let's see your toes bit hard for me can you see 1 side no can you push on the other side don't need to push it up excellent and hearing okay no change to your hearing hearing is fine yeah my actual hearing you have said that your ears are like itchy yeah sometimes like my inner ear will feel itchy but why don't we just give it a good like yeah good tug around yeah no no it's fine but okay that's probably just crap in it from work more than anything would dust and stuff yeah fine did jack did ben look in your ears no no fine no okay just keep looking real quick okay stop I'll it I'll keep it I'll just keep just a little bit of pinch of a bit of a soreness I'm going to stop the bleeding so it's bit rougher and have a quick look fine and can I see you stood up is that okay lovely open your eyes for me just to make sure you've got nothing and then open your eyes again I've got a little bit of a bunch of you like this just close your eyes okay could you march on the spot that's fine anything else that you've got wanted to do it's alright you know I I I was in close his eyes yeah a while ago and he was wobbling all the like I'm going backwards when close my eyes really weird he was wobbling quite a lot so then close your eyes again and put your eyes out you're dressed well thank you yeah thank you I'm not dressed more than that yeah if you're comfortable to me okay okay and then coming back to me do you see heel to toe in your heel that's okay and then the last 1 could I ask you to do a bit of clapping like like this for me not big can you get any higher can you do any faster very good other side any eyes no not quite I don't think it's normal to examine you in terms of your cranial nerves and all of the signs to do with a sort of posterior straight which is we're trying to exclude I'll have a chat to the radiologist and try and get you an mri scan if they say no it may be that bringing you back to 1 of our clinics where we look at people who might have had a stroke or might have had a small mini stroke to see 1 of the stroke consultants make better cardiac clinics and often they suggest doing an mri scan in this situation but sometimes the radiologist wants you to be seen by a consultant before which is fine and in that case we'll get that sorted out before you in the room instead of just going straight for the mri scan does that sound okay any questions or anything I've forgotten no no no were you some heart with the ecg with the little bit of the yeah he had this thing and then things like bundle branch block you didn't yeah yeah would that make him feel tired or anything that's just how are someone's like born with that or is that just because of his age so often athletic young men will have this on their on their ecg and it's it's a factor of the normal what we call normal for the average person and if you're a thin athletic young man like it sounds like you are you'll pop you know you will see this on an it's because your heart is slightly thicker than our normal ranges because it's strong means that the electricity travels through slightly further because it's thicker and you get this on these we'd see it as a normal variant of people you know a certain percentage of people that can't quite figure unfortunately but will have this as part of a normal range so I wouldn't worry about that okay it's okay to karen excellent that was it yeah karen you're running I'm alright that's cool that's fine it's just that we're basic of course your heart yeah no no oh my god do an hour but he went oh that's a bit unusual for a 25 year old you know what added but actually an yeah if you had a full a complete right bundle branch block it would be slightly abnormal you'd think oh why is that going on but you but looking at your ecg it's incomplete I e it's not longer than we would really like it to be the it's bit academic and a bit technical but it's within the realm of normality so I wouldn't worry about it yeah alright yeah thank you no it's okay I was like when he said a new lab and he went that's a bit abnormal and I thought yeah but it's fine but yeah they looked at some ecgs but that's fine thank you very much fine cool daphne you're going to speak to the radiologist I'm try and see if I can source any help for you can I put you back in there just so you can hear from me is that alright you for that sorry been waiting an hour to talk to you once day fine fine but you'll get some of these in for you no no it's fine it's nice to meet you a long clam we'll come back in there