Review Question - QID 105004

This patient is presenting with intermittent, severe vertigo which is provoked by position changes which is most consistent with benign paroxysmal positional vertigo (BPPV). BPPV is commonly caused by canalithiasis.

Benign paroxysmal positional vertigo (BPPV) is a common form of peripheral vertigo that results from a dislodged piece of otolith (called otoconia when dislodged) causing disturbances in the semicircular canals. The presentation of BPPV involves sudden and episodic vertigo with head movements that lasts for seconds to minutes accompanied by nausea and vomiting. Physical exam will demonstrate a horizontal nystagmus with specific head postures (such as the Dix-Hallpike maneuver). Treatment involves repositioning exercises (such as the Epley maneuver) as well as meclizine or diphenhydramine for symptomatic control.

Figure/Illustration A is an ECG with an irregularly irregular rhythm (red arrows) without P waves (blue arrows).

Incorrect Answers:
Answer 2: Increased endolymph production describes Meniere disease which presents with chronic symptoms including hearing loss and ear fullness and intermittent episodes of vertigo. Treatment involves diuretics and salt restriction.

Answers 3-4: Inflammation of the vestibular apparatus and the vestibulocochlear apparatus describes vestibular neuritis (sustained/persistent vertigo after a cold) and labyrinthitis (sustained/persistent vertigo and hearing loss after a cold), respectively. This condition will resolve on its own; however, symptoms can be treated with meclizine or diphenhydramine.

Answer 5: Vertebrobasilar insufficiency can present with syncope or if there is a hemorrhage/ischemia, may present in an elderly patient with multiple risk factors with sustained and severe vertigo that is sudden onset and associated with dysarthria and dystonia.

Bullet Summary:
Benign paroxysmal positional vertigo is commonly caused by canalithiasis.