Question

A 65-year-old woman presents to the Emergency Department with acute onset vertigo. She denies associated decreased hearing or tinnitus. Vital signs are normal. Horizontal head impulse test shows a corrective saccade when the head is turned to the left. Dix-Hallpike maneuver elicits a leftward horizontal nystagmus that is fatigable. Which of the following mechanisms will provide the most definitive treatment of this condition?

a) Dopamine receptor antagonism
b) Inhibition of the reabsorption of sodium from the distal convoluted tubules
c) Positive allosteric modulators of GABA type A receptors
d) Relocation of free floating otoconia

Answer 1

The most definitive treatment for a 65-year-old woman presenting with symptoms consistent with BPPV is the relocation of the free floating otoconia back to their original location in the utricle.

Step-by-step explanation:

The 65-year-old woman with acute onset vertigo likely has Benign Paroxysmal Positional Vertigo (BPPV), indicated by the described symptoms and results of the horizontal head impulse test and Dix-Hallpike maneuver. BPPV causes periods of dizziness because free floating otoconia (calcium carbonate crystals) migrate from the utricle into the semicircular canals, where they inappropriately stimulate the hair cells, leading to false signals of head movement being sent to the brain. Gravity acts on these otoconia, causing stimulation of the hair cells in the semicircular canals when the head is positioned in certain ways. The most definitive treatment of the condition is the relocation of the free floating otoconia back to their original location using procedures like the Epley maneuver.