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CN VIII schwanomma
6%
6/97
Brainstem mass
2%
2/97
Ménière's disease
79%
77/97
Benign paroxysmal peripheral vertigo (BPPV)
3%
3/97
Drug-induced ototoxicity
7%
7/97
Select Answer to see Preferred Response
The patient in this vignette most likely has Ménière's disease, as evidenced by episodic vertigo with hearing loss and aural fullness. Ménière's disease is caused by abnormal accumulation of endolymph in the inner ear. The classic constellation of Ménière's disease consists of four symptoms: episodic dizziness or whirling vertigo, low-frequency sensorineural hearing loss, tinnitus, and a sensation of aural fullness in the ear. These symptoms may or may not develop simultaneously. This is in contrast with a CN VIII lesion (central vertigo) which presents similarly but with absence of "fullness" in the inner ear. Incorrect Answers: Answer 1: A CN VIII Schwanomma may produce similar symptoms but would most likely not be episodic in nature. Answer 2: A brainstem mass compressing the vestibulocochlear nerve may produce similar symptoms but would most likely not be episodic in nature. Answer 4: BPPV presents with episodic vertigo but is not associated with hearing loss. Answer 5: Drug-induced ototoxicity may produce similar symptoms but would not likely be episodic. Of note, ACE inhibitors and statins are not common causes of ototoxicity, while loop diuretics and aminoglycosides are the most common culprits.
4.8
(4)
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