A Case of Central and Peripheral Vestibular Impairment
MM is a 64-year-old female referred from an otolaryngologist for a second opinion regarding intermittent episodic positional vertigo occurring only with changes in head position and persistent unsteadiness of gait. MM’s primary concern was that her gait disturbance had become significantly worse over the last 6 years, but had been present for the past 25 years. At the time of the consultation, MM described two distinct forms of dizziness. First, MM reported a sensation of nausea and light-headedness with true vertigo provoked by changes in body position (e.g., looking up and bending over). Second, she described progressively worsening disequilibrium when walking or standing. During the direct patient interview, it was revealed that 6 years ago MM experienced a severe episode of true vertigo that lasted approximately 2 days. Of further note is MM had a history of persistent moderate alcohol intake (an average of 12 drinks per weekend) for the last 25 years. When questioned about her hearing, MM reported she had bilateral hearing loss and it had progressed slowly over the last 10 years. She denied any fluctuation in hearing, aural fullness, or tinnitus. At the time of presentation, she carried diagnoses of depression, restless leg syndrome, and Meniere’s Disease (MD; diagnosed 28 years prior). Her management at the time of the appointment consisted of a low salt diet, diuretic for the MD, and pramipexole for restless leg syndrome.