Case Scenario
- A 41-year-old female came to your clinic after unsuccessful and unusual evaluation and treatment for dizziness elsewhere. She stated that in the summer of 2018, she had experienced brief episodes of dizziness, which disappeared in about 1 month without treatment. In May of 2019, she experienced a recurrence of the symptoms. Her dizzy spells had never lasted more than a few seconds and had always been precipitated by motions such as rolling over in the bed to the left and getting out of bed in the morning. She stated that her symptoms had not varied from the first one.
Neurologic Evaluation
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Neurologic evaluation within our clinic demonstrated normal mental status, language, blood pressure, and cranial nerve function.
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There was some mild, direction-fixed, right-beating positional nystagmus with eyes closed and alerting in the supine, head-left, and head-hanging positions.
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The dix-Hallpike maneuver demonstrated a classic response in the head-hanging-left position; the response consisted of paroxysmal, clockwise nystagmus, which began approximately 5 seconds after assuming the position. The response was accompanied by the patient’s report that she was dizzy and that the sensation duplicated the spells she had been having.
Questions
- What is the differential diagnosis for this case?
- What further questions in the history?
- What clinical examination will you perform?
- Are there needs for any investigations?
- What is your approach to help her?
- What is the maneuver shown to abate this condition?