ENG in a 70-year-old woman with dizziness and inability to look down.A 70-year-old woman came to the office with a 4-year history of dizziness and tinnitus in the right ear. When her symptoms first began, she would experience a sense of imbalance that started whenever she got out of a car; the feeling would be gone by the next morning. These episodes lasted for about 1 year. At that point, her dizziness no longer dissipated; in fact, it intensified. The woman described her dizziness as a spinning feeling while she was lying down and imbalance on arising, standing, and walking. She added that there were times when she experienced a "peculiar feeling" in her head. Three weeks prior to her visit, she had been hospitalized for a "drop attack," which was characterized by retching retching /retch·ing/ (rech´ing) strong involuntary effort to vomit. retching an unproductive effort to vomit. and a severe spinning feeling. In the interim, she had progressed from needing a walker to using a cane. When her history was being taken, the patient said that she felt best when her head was tilted up and to the left. She said she was unable to look down, and until recently, she was unable to get out of bed. For some time she had been unable to lie on her right or left side without experiencing a "horrible" spinning. She said she was now able to walk four or five times a day with assistance. Electronystagmography revealed a direction-fixed right beating nystagmus Nystagmus Definition Rhythmic, oscillating motions of the eyes are called nystagmus. The to-and-fro motion is generally involuntary. Vertical nystagmus occurs much less frequently than horizontal nystagmus and is often, but not necessarily, a sign of in all positions, with 2[degrees]/sec in the 30[degrees] supine position. Her alternate binaural binaural /bi·nau·ral/ (bi-naw´r'l) pertaining to both ears. bin·au·ral adj. Having or relating to both ears. binaural pertaining to both ears. bithermal test was normal for reduced vestibular response and directional preponderance corrected for the 2[degrees]/sec pre-existing right beating nystagmus. A simultaneous binaural bithermal test showed a corrected type 3 right-beating nystagmus of 3[degrees]/sec. Sinusoidal sinusoidal /si·nus·oi·dal/ (si?nu-soi´dal) 1. located in a sinusoid or affecting the circulation in the region of a sinusoid. 2. shaped like or pertaining to a sine wave. vertical-axis rotation testing revealed normal gains, phase lags were consistent with a peripheral vestibular disorder peripheral vestibular disorder Neurology A hallucination of movement, either subjective or objective History Duration of an attack–eg, hrs v. days, frequency daily v. , and abnormal symmetry to the left was consistent with an incomplete central compensation. Ocular fixation of rotation-induced nystagmus was present and complete. Magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. and magnetic resonance angiography Magnetic resonance angiography A noninvasive diagnostic technique that uses radio waves to map the internal anatomy of the blood vessels. Mentioned in: Cerebral Aneurysm magnetic resonance angiography were both negative for central nervous system pathology. In total, all findings were compatible with a peripheral vestibular disorder. From Neurotologic Associates, P.C., New York City. |
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