Dizziness
A 35 years-old-man consulted his family physician because of some recent episodes of what he described as dizziness. He was concerned that this complaint might be related to a fall from a stepladder that had occurred the previous month, although his symptoms did not begin immediately after the incident. At the time of his visit to the doctor, his symptoms are minimal, and he appears to be in good general health. He states that the feeling of dizziness, which also included sensation of nausea (without vomiting) and “ringing in the ears”, makes his feel as though his surroundings were spinning around him. The episodes, which could last for several days at a time, are quote annoying and sufficiently severe to cause him concern for his safely on the job. When questioned, he indicates that he also may not be hearing as well as he should, but at other times he does not notice any hearing problems. He further indicates that he may have had occasional dizzy spells before the ladder incident, but that they now appear to be much more frequent. The only medication he takes is aspirin for an occasional headache. He has no difficulty in following a moving finger with head held stationary, and on the day of the visit he walks with a normal gait. He reports no light- headacheness with moderate and continued exertion.
Gentle irrigation of his external ear canals with warm water produces a feeling of dizziness and nausea accompanied by nystagmus. The subjective sensations appeared to be the same for each ear. He is further evaluated with the Dix-Hallpike maneuver, and no sensations of vertigo are elicited during the positional maneuvers. However, when he is rapidly rotated in a swivel chair, he reports dizziness that was more several that his usual symptoms. Rotation in the opposite direction produced similar symptoms. His physician advises him that may be some appropriate specific medication for his condition, but may would first like him to try a salt restricted diet. He also prescribes mild diuretics.
Upon his return visit 4 weeks later, the patient reports a gradual lessening of the frequency and duration of his spells of dizziness and accompanying symptoms.
What feature of this case would indicate that trauma from the stepladder incident was not the precipitating cause of the symptoms and what factors would tend to rule out a diagnosis of begin paroxysmal positional vertigo?
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