Review Question - QID 109114

This patient had a brief episode of vertigo, nausea, and vomiting and exhibits a positive Dix-Hallpike test, which is most consistent with benign positional vertigo (BPV). The best treatment is the Epley maneuver, which repositions particles in the inner ear.

BPV presents with sudden movement followed by intense vertigo, nausea, and vomiting. The episodes typically last less than one minute, but feeling imbalanced afterward is commonplace. The Dix-Hallpike test is the principle method of diagnosing BPV. The Epley maneuver repositions the free-floating calcium particles, which are felt to be the source of the symptoms, from the semicircular canal into the utricle and is the first-line treatment.

Incorrect Answers:
Answer 2: A thiazide diuretic would be appropriate for Meniere’s disease, which presents with vertigo, tinnitus, and hearing loss with a feeling of fullness in the ear. The medication works to reduce endolymph build-up in the inner ear.

Answer 3: Triptan therapy is an abortive treatment for migraine headaches and acts through agonist activity at the serotonin 5HT-1B and -1D receptors. Although migraines can cause vertigo, nausea, and vomiting, and this patient does have a history of migraines, they would not produce a positive Dix-Hallpike test.

Answer 4: Meclizine is an antagonist at the histamine H1 receptor and can be used as second-line therapy for BPV. It acts by depressing vestibular stimulation, but the Epley maneuver should be attempted first.

Answer 5: Increased fluid intake would be useful in orthostatic hypotension, which, like BPV, occurs with sudden rising. Although this patient did run a race and is therefore at risk for dehydration, his symptoms are more consistent with BPV (positive Dix-Hallpike test).

Bullet Summary:
The Epley maneuver, which repositions calcium particles in the inner ear, is the first-line treatment for benign positional vertigo.