What Path will be chosen?

65 year old retired man

disequilibrium

Rapid head movement made dizziness worse and caused blurred vision

Untitled Slide

• No Tinnitus
• No Aural fullness
• prescribed meclizine..(some relief) 
• pt no longer went for walks, drove, or gardened
• continued to have daily dizziness

Choose diagnosis now!

That guess leaves a bad taste in your mouth!

Additional Info

• No change in hearing
• no positional symptoms  
• began w/ acute vertigo lasting several hours with vomiting
• no prior medical history
• walks with rigid head, severely limits movement

Physical Examination

• slight right beating nystagmus on right lateral gaze
• head held rigidly during walking
• slow gait
• head thrust test abnormal to left
• Dix-Hallpike negative

Lab Tests

• indicate pt has left unilateral peripheral dysfunction
• ongoing vestibulo-ocular and vestibulospinal asymmetry
• posturography abnormalities suggest dependence on rigid surface for balance

Symptoms point to vestibular neuritis. The patients continued symptoms suggest impaired compensation

why the slow compensation?

Causes of impaired Compensation

• fluctuating vstibular function
• CNS abnormality
• Medication induced
• sedentary lifestyle/fear of head movement
• multisensory impairment

slow compensation over time could be attributed to him limiting his head movement or the meclizine suppresing vestibular input

Treatment/Management

• gradually discontinue meclizine 
• vestibular rehab to reduce symp.
• eliminate his surface dependence

Untitled Slide

Untitled Slide