Case history
Case history
A 65-year-old woman presents with a chief complaint of dizziness. She describes it as a sudden and severe spinning sensation precipitated by rolling over in bed onto her right side. Symptoms typically last <30 seconds. They have occurred nightly over the last month and occasionally during the day when she tilts her head back to look upwards. She describes no precipitating event prior to onset and no associated hearing loss, tinnitus, or other neurological symptoms. Otological and neurological examinations are normal except for the Dix-Hallpike manoeuvre, which is negative on the left but strongly positive on the right side.
Other presentations
Benign paroxysmal positional vertigo (BPPV) can occur as a result of a closed-head injury or vestibular neuronitis, and it can also be associated with Meniere's disease or migraine. Most patients give the classic description of a short-lived vertigo sensation following rolling over in bed. However, many patients may not sense an actual turning sensation and may use other dizziness descriptors to describe their sensation. Because of the frightening intensity of the sensations, patients often report that the spells last for 5 or 10 minutes when in reality they typically last for no more than 20 seconds.
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