A 65-year-old man
presented with a 2-week history of worsening vertigo. The sensation of vertigo
was constant and exacerbated by turning in bed, sitting, and standing. Exacerbations
lasted 5–10 minutes and were intense enough to cause gait impairment. Two days
prior to presentation, the vertigo had worsened in severity and was associated
with one episode of nausea and vomiting. Review of systems was positive for a
3-month history of a whistling noise in the patient’s left ear, a 2-week
history of acute-on-chronic left-sided hearing impairment, and a recent upper
respiratory infection. The patient’s medical history was notable for a left radical
mastoidectomy performed 14 years prior to presentation for treatment of
complications of chronic otitis media, which resulted in chronic leftsided hearing
impairment. Medical history also included hepatitis C and remote alcohol and
heroin abuse.
Questions for consideration:
1. What is the differential diagnosis for vertigo?
2. How do we clinically differentiate the peripheral
causes of vertigo
from central causes of vertigo?
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