Differential Diagnosis of Central versus Peripheral Vertigo
EM is a 51-year-old female who was referred for vestibular evaluation. EM presented with a complicated medical history including recent diagnosis of celiac disease, severe anemia requiring blood transfusion, shingles, and bradycardia (abnormally low resting heart rate) resulting in hospitalization. EM also had a significant history of alcohol and drug abuse 17 years earlier resulting in seizure disorder and bipolar disorder regulated with lithium. EM reported that loud sounds can trigger her seizures. EM’s medical history was also positive for migraines regulated with sumatriptan. EM was involved in a car accident 20 years ago resulting in loss of consciousness and subdural hematoma. EM reports that 1 month following the car accident she was told she had acute labyrinthitis and was prescribed meclizine which EM took daily for 9 months. Antivert is a vestibular suppressant that is typically used to alleviate vertigo during the acute phase. It is not intended for long-term use because it can result in chronically uncompensated vestibulopathy.