Case 22 - 53 yo M with dizziness

Question 1

Differential diagnosis

Answer 1

Meniere’s disease
Benign paroxysmal positional vertigo
Orthostatic hypotension causing dizziness

Question 2

Physical examination

Answer 2

HEENT (nystagmus, funduscopic exam, otoscopy, assessed hearing, Rinne and Weber tests, inspected mouth and throat)
CV exam (including auscultation and orthostatic vital signs)
Neurologic exam (CNs, motor exam, DTRs, gait, Romberg's test, tilt test [Dix-Hallpike maneuver])

Question 3

Closure

Answer 3

Be careful when standing up quickly or walking unassisted, and use hand railings whenever possible
Do you have any questions for me?

Question 4

Differential diagnosis

Answer 4

Meniere’s disease (room spinning, L-sided hearing loss)
Benign paroxysmal positional vertigo (room spinning, onset with position changes, duration of 20-30 minutes)
Orthostatic hypotension causing dizziness (h/o diarrhea, anti-HTN medication)

Question 5

Diagnostic work-up

Answer 5

Dix-Hallpike maneuver
Audiometry
MRI - brain

Question 6

Meniere’s disease

Answer 6

Episodic vertigo (lasting 1-8 hours)
Low-frequency hearing loss
Tinnitus
Sensation of aural fullness

Associated with syphilis, so may want to check VDRL/RPR

Question 7

Benign paroxysmal positional vertigo

Answer 7

Transient vertigo following changes in head position

No hearing loss

Question 8

Labyrinthitis

Answer 8

Follows viral infection, such as URI
Hearing loss
Tinnitus
Continuous vertigo (lasting days to weeks)

Question 9

Acoustic neuroma

Answer 9

Continuous dysequilibrium

Other neurologic findings on exam