Vertigo

Presenting History: - The patient reports the sudden onset of vertigo approximately 2 hours prior to presentation. - The patient denies any chest pain, shortness of breath, palpitations, dizziness on standing or syncope. - The patient denies any motor, sensory, visual, coordination, or speech-related symptoms. - The patient denies any head, neck, or facial pain. - The patient reports mild tinnitus in the left ear. - The patient denies any fever, back pain, abdominal pain, urinary complaints or generalised malaise. - The patient denies any recent trauma, head injury, or chiropractic manipulation involving the neck. - The patient describes the vertigo as a spinning sensation, lasting for several minutes at a time, triggered by head movements, and associated with mild nausea. Past Medical History: - The patient has a history of hypertension, well-controlled with medication. - Medications: Lisinopril 10mg daily. - Allergies: No known allergies. Vital Signs: - Blood pressure 130/80 mmHg, heart rate 78 bpm, respiratory rate 16 breaths/min, temperature 37.0°C. Neurological & Vestibular Examination: - Cranial nerves II-XII intact. Normal limb tone, reflexes 2+ and symmetrical. Coordinated finger-to-nose and heel-to-shin testing. Gait normal. - HINTS exam: Head impulse test negative, downbeat nystagmus present, no skew deviation. Balance Assessment: - Romberg test: slight sway. Tandem gait: unsteady. Dix-Hallpike test: positive for left ear. - Audiometry and VNG performed. - Findings are suggestive of peripheral vestibular dysfunction, likely left-sided. - Patient demonstrated unsteadiness during tandem gait. Red Flag Screening: - No red flags identified. Clinical Impression: - Benign paroxysmal positional vertigo (BPPV), left ear. Management Plan: - Epley maneuver performed, with resolution of vertigo. Patient instructed on home exercises. - Patient advised to return if symptoms worsen or do not improve within 2 weeks.