Question

What are the three diagnoses that should be considered when working up isolated vertigo (ABCs) and how do you distinguish each

Answer 1

The three diagnoses to consider for isolated vertigo are BPPV, acute vestibular neuronitis or labyrinthitis, and Ménière's disease. They are differentiated through clinical presentation, special tests like the Dix-Hallpike test for BPPV, and ruling out other causes with examinations like audiometric tests and neurological exam subtests.

Step-by-step explanation:

The three diagnoses to consider when evaluating isolated vertigo are:

1. Benign paroxysmal positional vertigo (BPPV) - BPPV is characterized by brief episodes of vertigo related to changes in head position. It is diagnosed with the Dix-Hallpike test, where the patient rapidly transitions from sitting to lying with the head turned to the side. A positive test is indicated by transient vertigo and characteristic nystagmus (a rapid involuntary movement of the eyes).
2. Acute vestibular neuronitis or labyrinthitis - Often following a viral infection, it presents with sudden and prolonged vertigo, possibly accompanied by hearing loss in the case of labyrinthitis. There are no specific tests, but diagnosis is based on clinical presentation and ruling out other causes.
3. Ménière's disease - Patients can have episodes of vertigo, a sensation of fullness in the ears, tinnitus, and fluctuating hearing loss. Diagnosis is primarily clinical but may be supported by audiometric tests and testing for excess fluid in the inner ear, as fluid accumulation is a suspected cause.