First Case: Waking Up With Dizziness
A 28-year-old communications director presented to her family physician with a 2-month history of dizziness, nearly always upon awakening from bed. The dizziness occurred almost every day, but lasted no more than a minute each time.
The patient denied fever, chills, or nausea, as well as hearing loss, ear pain, or tinnitus. She was otherwise healthy, with no history of surgery, trauma, or allergies.
Physical examination demonstrated an alert and well-nourished woman with normal vital signs. Head and neck examination was unremarkable, and motor and sensory neurologic exam was grossly normal. However, during the Dix-Hallpike maneuver, the patient demonstrated rotatory up-beating nystagmus with the right ear facing downward, as well as mild nausea and dizziness. The symptoms abated when the patient sat upright.
The patient was ultimately diagnosed with benign paroxysmal positional vertigo (BPPV).
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Cite this: BPPV: What to Do About Dizziness - Medscape - Apr 20, 2017.