A 40-year-old man presents to the clinic for dizziness which began this morning. After waking up, he has been experiencing a spinning sensation not lasting more than a minute at a time, associated with nausea. He has had some lightheadedness during the day but denies hearing loss or tinnitus. He recently recovered from an upper tract illness three weeks ago. Past medical history is unremarkable, and he does not take any medications. Vital signs are normal.
B) Dix-Halpike test and Epley maneuver.
This patient most likely has benign paroxysmal positional vertigo (BPPV), characterized by sudden onset, recurrent, and brief vertigo that occurs with positional changes of the head. It is diagnosed with the Dix-Hallpike test and treated with canalith repositioning maneuvers such as Epley maneuver.
Answer choice A: CT scan of the brain, is incorrect. Brain imaging is indicated if there is concern for tumor. Although the patient has nausea, the spinning sensation is short-lived and does not result in vomiting. Additionally, the patient had upper tract illness prior to these symptoms which makes the diagnosis of BPPV more likely.
Answer choice C: Meclizine, is incorrect. Meclizine is a treatment used for motion sickness, especially in Meniere disease.
Answer choice D: MRI of the brain, is incorrect. Brain imaging is indicated if there is concern for tumor. Although the patient has nausea, the spinning sensation is short-lived and does not result in vomiting. Additionally, the patient had upper tract illness prior to these symptoms which makes the diagnosis of BPPV more likely.
Answer choice E: Vestibular and balance rehabilitation therapy, is incorrect. Vestibular and balance rehabilitation therapy is used if vertiginous symptoms persist after appropriate initial treatment.
Key Learning Point
The Dix-Hallpike test is a diagnostic maneuver used to identify benign paroxysmal positional vertigo (BPPV). The Epley maneuver is used to treat BPPV once it has been diagnosed by the Dix-Hallpike test.
