View source for WBR1079

 {{WBRQuestion
|QuestionAuthor=Chetan Lokhande
|ExamType=USMLE Step 2 CK
|MainCategory=Internal medicine
|SubCategory=Head and Neck, Neurology
|MainCategory=Internal medicine
|SubCategory=Head and Neck, Neurology
|MainCategory=Internal medicine
|SubCategory=Head and Neck, Neurology
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Head and Neck, Neurology
|MainCategory=Internal medicine
|SubCategory=Head and Neck, Neurology
|MainCategory=Internal medicine
|SubCategory=Head and Neck, Neurology
|MainCategory=Internal medicine
|SubCategory=Head and Neck, Neurology
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Head and Neck, Neurology
|Prompt=A 50-year-old man comes to your office with complaints of dizziness only while turning his head left or right. He noticed that it happens when he is looking on the sides while driving. It stays only for 10 seconds and disappears when he looks again in the front. The patient reports no hearing loss, tinnitus and ataxia. What is the most probable diagnosis?
|Explanation=This is a classical history of Benign paroxysomal positional vertigo (BPPV). BPPV is a disorder of the vestibular system usually affecting balance. Patients often describe their first experience occurring while turning their head in bed or while driving a car .
The vertigo is brief in duration — 5 seconds to 30 seconds.It is often associated with nausea. No other neurological deficits are noted. However care must be taken and a posterior circulation stroke should be kept in mine while treating these patients.

'''Educational Objective'''
A vertigo lasting for a few seconds and associated or brought about by change in position is Benign positional vertigo unless proved otherwise.
|AnswerA=Vestibular Neuronitis
|AnswerAExp=The main symptom of vestibular neuronitis is vertigo, which appears suddenly, often with nausea and vomiting. This can be made worse by head movement. Vertigo usually lasts for several days or weeks. In rare cases it can take months to go away entirely. Vestibular neuronitis does not lead to loss of hearing. A common indication is horizontal nystagmus with the fast beat towards the healthy ear.  The main differentiating factor is that vestibular neuronitis stays for weeks whereas BPPV lasts for few seconds.

|AnswerB= Labyrinthitis
|AnswerBExp=Nausea, anxiety, and a general ill feeling are common due to the distorted balance signals that the brain receives from the inner ear.A prominent and debilitating symptom of labyrinthitis is severe vertigo. When the vestibular system is affected by labyrinthitis, rapid and undesired eye motion (nystagmus) often results from the improper indication of rotational motion. Hence nystagmus is the key differentiating feature of labyrinthitis . 
|AnswerC=Benign Positional Vertigo (BPPV)
|AnswerCExp=Patients often describe their first experience occurring while turning their head in bed.
The vertigo in BPPV is brief in duration — 5 seconds to 30 seconds, often associated with nausea. Patients do not experience other neurological deficits such as numbness or weakness. Since the patient symptoms lasts only for a few seconds and he has no associated symptoms the answer is BPPV .
|AnswerD=Meniere’s Disease
|AnswerDExp=Meniere's disease is characterized by a triad of vertigo, tinnitus and deafness . Since the patient doesn't have these symptoms it is not the correct answer.
|AnswerE=Hypertension
|AnswerEExp=Hypertension will present with features like headache, blurry vision, dyspnea, tinnitus, fatigue and drowsiness. The symptoms wont be lasting for a few seconds . 
|RightAnswer=C
|WBRKeyword=Benign positional vertigo , vertigo
|Approved=Yes
}}