Auditory & Vestibular System - Clinical Case Flashcards
An 81-year-old male comes to consultation due to sudden and intermittent vertigo crisis which started 2 days ago.
He got up from bed one day and he felt everything in the room was moving around in circles, like a carrousel. He had to sit quickly and the spinning improved in the next few minutes. From that moment he felt a bit “weird” during the day but did not experience the same episode until the evening when lying down when he experienced the same symptoms; very strong room spinning sensation with nausea. He said that, again, it lasted a few minutes and then he fell asleep. The same event happened again the next day, so he decided to see a doctor. He does not feel completely stable and is very anxious about this happening again, as he cannot even stand nor do anything when the spinning occurs. When still, he does not feel dizzy and does not experience any major symptom. When asked about any hearing problem, he refers having the feeling of hearing less from about 10 years, and that it could be worse now as he needs clarification quite often when having a conversation. He does not mention any new hearing symptom accompanying the dizziness.
What is a suitable diagnosis for this case?
Benign Paroxysmal Positional Vertigo (BPPV)
An 81-year-old male comes to consultation due to sudden and intermittent vertigo crisis which started 2 days ago.
He got up from bed one day and he felt everything in the room was moving around in circles, like a carrousel. He had to sit quickly and the spinning improved in the next few minutes. From that moment he felt a bit “weird” during the day but did not experience the same episode until the evening when lying down when he experienced the same symptoms; very strong room spinning sensation with nausea. He said that, again, it lasted a few minutes and then he fell asleep. The same event happened again the next day, so he decided to see a doctor. He does not feel completely stable and is very anxious about this happening again, as he cannot even stand nor do anything when the spinning occurs. When still, he does not feel dizzy and does not experience any major symptom. When asked about any hearing problem, he refers having the feeling of hearing less from about 10 years, and that it could be worse now as he needs clarification quite often when having a conversation. He does not mention any new hearing symptom accompanying the dizziness.
Select and explain three elements of the story that support your hypothesis.
- The sudden and intermittent vertigo crisis which is very characteristic of this disorder.
- Short lasting (minutes) spinning vertigo
- Triggered when getting up and lying down.
- He does not refer to any symptoms when standing still
- He does not mention any new hearing symptom accompanying the vestibular event, the hearing problems are clearly coming from previous time.
An 81-year-old male comes to consultation due to sudden and intermittent vertigo crisis which started 2 days ago.
He got up from bed one day and he felt everything in the room was moving around in circles, like a carrousel. He had to sit quickly and the spinning improved in the next few minutes. From that moment he felt a bit “weird” during the day but did not experience the same episode until the evening when lying down when he experienced the same symptoms; very strong room spinning sensation with nausea. He said that, again, it lasted a few minutes and then he fell asleep. The same event happened again the next day, so he decided to see a doctor. He does not feel completely stable and is very anxious about this happening again, as he cannot even stand nor do anything when the spinning occurs. When still, he does not feel dizzy and does not experience any major symptom. When asked about any hearing problem, he refers having the feeling of hearing less from about 10 years, and that it could be worse now as he needs clarification quite often when having a conversation. He does not mention any new hearing symptom accompanying the dizziness.
Could the hearing problem and the dizziness be related? Explain.
Highly unlikely
* BPPV affects only the semi-circular canals where the crystals are floating around, then the hearing would not be affected
* Consider:
* Started 10 years ago, worse over time, slow and progressive nature of the hearing loss and the absence of specific triggers
* Age of the patient
