A case on dizziness:
A 46 years-old male patient complains of dizziness for 2 days duration. Upon questioning him on the nature of his problem, he says he feels as if the room is spinning, and it sometimes causes him nausea. He says the condition started 2 days ago when he rolled in his bed while asleep, he was suddenly caught by an attack of dizziness that lasted for about a minute or less and then disappeared. During the next few days, the attacks would come to him while tying his shoes or grabbing something from the top shelf.
He has hypertension, and is well controlled by medication. He says he suffered from a similar attack a few years ago but it resolved on its own.

On examination, he does not have any neurological issues, and his BP is 138/87.

So the dx is:

Pathophysiology

Signs & symptoms

Diagnosis & treatment

Patients with all 4 criteria usually have BPPV (88% sensitivity, 92% specificity):

• Recurrent vertigo.
• Duration of attack < 1 min.
• Symptoms invariably provoked by changing head position like lying down or turning over in bed .
• Not attributed to another disorder.

• Most patients with BPPV complained that turning over in bed provoked the vertigo.
• Also, about 50% of patients complain of imbalance, yet they fall only rarely, so recurrent falling should make you suspect other, alternative diagnoses.

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+ Patients with positive findings

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