for Team. - vanco

[ArchivalUser]

For the last 5 weeks a 35-year-old female has had episodes of intense vertigo that last several hours. Each episode is associated with tinnitus and a sense of fullness in the right ear; during the attacks she prefers to lie on the left side. Examination during an attack shows that she has fine rotary nystagmus that is maximal on gaze to the left. There are no ocular palsies, cranial nerve signs, or long-tract signs. An audiogram shows high-tone hearing loss in the right ear, with recruitment but no tone decay. The most likely diagnosis in this case is

A. labyrinthitis
B. Ménière's disease
C. vertebral-basilar insufficiency
D. acoustic neuroma
E. multiple sclerosis

[ArchivalUser]

BBB

[ArchivalUser]

The symptoms and signs described in this question are most consistent with Ménière's disease. In this disorder paroxysmal vertigo resulting from labyrinthine lesions is associated with nausea, vomiting, rotary nystagmus, tinnitus, high-tone hearing loss with recruitment, and, most characteristically, fullness in the ear. Labyrinthitis would be an unlikely diagnosis in this case because of the hearing loss and multiple episodes. Vertebral-basilar insufficiency and multiple sclerosis typically are associated with brainstem signs. Acoustic neuroma only rarely causes vertigo as the initial symptom, and the vertigo it does cause is mild and intermittent