A 44-year-old Caucasian female presents to your office complaining of severe, episodic dizziness for the last year or two. During the episodes, she feels that the room is spinning and she can't walk. The episodes last for one or two hours and resolve spontaneously. She also noticed periodic decreased hearing and ringing sensation in her left ear. She has right knee osteoarthritis, and takes Tylenol and aspirin 2-3 times a day to cope with the pain. She does not smoke or consume alcohol. Her blood pressure is 130/83 mmHg and heart rate is 74/min while standing, and 128/85 mmHg and 76/min, respectively, while supine. What is the most likely diagnosis in this patient?

Question

A 44-year-old Caucasian female presents to your office complaining of severe, episodic dizziness for the last year or two.  During the episodes, she feels that the room is spinning and she can't walk.  The episodes last for one or two hours and resolve spontaneously.  She also noticed periodic decreased hearing and ringing sensation in her left ear.  She has right knee osteoarthritis, and takes Tylenol and aspirin 2-3 times a day to cope with the pain.  She does not smoke or consume alcohol.  Her blood pressure is 130/83 mmHg and heart rate is 74/min while standing, and 128/85 mmHg and 76/min, respectively, while supine.  What is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

Explanation: This patient presents with a classic triad of periodic vertigo, unilateral hearing loss and tinnitus that is characteristic for Meniere's disease. Although many patients initially experience only some symptoms, most eventually go on to experience the full complement of the disease. Meniere's disease should be differentiated from a range of other conditions having similar presentations. (Choice B)Benign paroxysmal positional vertigo (BPPV) is characterized by typical acute vertigo attacks that are provoked by a change in position; however, unlike Meniere's disease, BPPV is not accompanied by hearing loss. (Choice A)Acoustic neuroma is an important consideration in this patient, but acute vertigo episodes are uncommon in patients with acoustic neuroma due to its gradual tumor growth. (Choice C)Aspirin toxicity may manifest as tinnitus and vestibular symptoms, but unilateral hearing loss does not occur with this condition. (Choice E)Multiple sclerosis can sometimes mimic Meniere's disease but usually presents with more widespread non-localized symptoms. Educational Objective: A classic triad of periodic vertigo, unilateral hearing loss and tinnitus is characteristic for Meniere's disease.

A 44-Year-Old Caucasian Female Presents to Your Office Complaining of Severe