Question:
A 55 year old headmaster complains of recurrent attacks of a perception of spinning lasting hours to days and associated with hearing loss. The onset is frequently sudden, reaching peak intensity within minutes and lasting for an hour or more before subsiding. He also complains of a feeling of ear fullness that resolves after episodes of vertigo. These attacks are accompanied by nausea, vomiting, and ataxia. A likely diagnosis is
a) occlusion of the right posterior inferior cerebellar artery
b) occlusion of the left superior cerebellar artery
c) Meniere's disease
d) acute labyrinthitis
e) senile calcific aortic stenosis
Correct Answer: C.
ReplyDeleteExplanation:
Periodic attacks of vertigo is the most disruptive of the symptoms to the patient. It is usually the vertigo attack which causes the patient to seek medical treatment. Typically, vertigo occurs in the form of a series of attacks over a period of weeks or months, interspersed by periods of remission of variable duration. The attack consists of a period of dizziness or vertigo (dizziness may include a feeling of unsteadiness; the term vertigo is normally reserved for the perception of spinning). The sensation of spinning may produce nystagmus (a beating of the eyes from side to side), nausea, vomiting, sweating and all the symptoms normally associated with extreme motion sickness. The onset of vertigo may be preceeded by a sensation of fullness or pressure in the ear, increased hearing loss and tinnitus.
The onset is frequently sudden, reaching peak intensity within minutes and lasting for an hour or more before subsiding. Unsteadiness may persist for the following hours or days. Treatment includes bed rest, IV fluids if unable to maintain hydration, antihistamines, and phenothiazines. Salt restriction and diuretics (such as hydrochlorothiazide or furosemide) may be helpful. Data are poor, but two thirds are reported to respond to either sodium restriction or diuretics. If severe symptoms, surgical ablation may be performed (labyrinthectomy if hearing is lost; vestibular nerve section if hearing is preserved).