The Question
A 68-year-old woman with a history of hypertension and hyperlipidemia presents to the emergency department with a two-hour history of recurrent, severe spinning sensations. She reports the episodes last for about 30 seconds and are provoked by rolling over to her right side in bed or looking up. She feels nauseated during the episodes but has not vomited. She denies any headache, hearing loss, tinnitus, double vision, or focal weakness. On examination, her vital signs are stable. Her neurologic examination, including a full cranial nerve assessment, motor and sensory testing, and cerebellar function, is entirely normal. There is no nystagmus in primary gaze. Which of the following is the most appropriate next diagnostic step?
See the answer and explanation below:
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A
Explanation
Clinical Pearl:
For patients with classic features of positional vertigo (brief, episodic, triggered by head movement) and a normal neurologic exam, the Dix-Hallpike maneuver is the diagnostic test of choice to confirm benign paroxysmal positional vertigo (BPPV).
Explanation:
Otolaryngology & Dental Medicine
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