Wiki Vertigo

Case Study: A Patient’s Journey Through Chronic Vertigo

Patient Profile

• Name: Sarah Johnson
• Age: 28 years
• Gender: Female
• Medical History: Generally healthy; no previous history of vertigo or significant medical issues. Non-smoker, moderate alcohol consumption. Works as a graphic designer and leads an active lifestyle.

Initial Symptoms

• Sarah began experiencing episodes of vertigo approximately six months ago, characterized by a spinning sensation that occurred spontaneously, without any obvious triggers.
• The episodes were unpredictable, lasting anywhere from a few seconds to several minutes.
• She reported associated symptoms, including nausea, imbalance, and difficulty concentrating during vertiginous episodes.
• Symptoms worsened with certain head movements, and she began to avoid activities such as exercising, driving, and socializing.

Initial Evaluation

1. Primary Care Visit:
   • During her initial visit to her primary care physician, Sarah described her symptoms as “feeling like the room is spinning” and mentioned that these episodes made her feel anxious and disoriented.
   • A thorough history was taken, and a physical examination was conducted.
2. Neurological Examination:
   • The neurological exam was unremarkable, with no focal deficits noted.
   • Sarah was referred for audiometric testing and vestibular evaluation.
3. Audiometry:
   • Pure tone audiometry and speech recognition tests revealed normal hearing thresholds bilaterally, with no signs of significant auditory impairment.
4. Vestibular Testing:
   • The Dix-Hallpike maneuver was performed, which was negative, suggesting BPPV was not the cause.
   • Caloric testing showed normal responses, indicating that the vestibular system was functioning adequately.

Further Assessment

• Given the chronicity and nature of her symptoms, Sarah was referred to a neurologist specializing in vestibular disorders for further evaluation.

1. Imaging:
   • An MRI of the brain was performed to rule out central causes of vertigo, such as tumors or structural abnormalities. Results were normal.
2. Comprehensive Evaluation:
   • After a thorough review, the neurologist diagnosed Sarah with chronic subjective dizziness (CSD), characterized by persistent dizziness with a normal vestibular exam.

Treatment Plan

1. Vestibular Rehabilitation Therapy (VRT):
   • Sarah was referred to a physical therapist specialized in vestibular rehabilitation. The therapy focused on balance exercises, gaze stabilization techniques, and habituation exercises to help manage her symptoms.
2. Cognitive Behavioral Therapy (CBT):
   • Given the anxiety and avoidance behaviors Sarah developed due to her symptoms, she was referred for cognitive behavioral therapy. The goal was to address her anxiety and develop coping strategies for dealing with vertigo.
3. Lifestyle Modifications:
   • Sarah was advised to maintain a healthy lifestyle, including regular physical activity, adequate hydration, and proper sleep hygiene. Stress management techniques, including mindfulness and relaxation exercises, were also recommended.
4. Follow-Up:
   • Sarah was scheduled for follow-up visits every four to six weeks to monitor her progress and adjust her treatment plan as necessary.

Journey Through Treatment

• Weeks 1-4:
  • Sarah began VRT and attended therapy sessions twice a week. She found the exercises challenging but noticed a slight improvement in her balance and a reduction in the frequency of her episodes. However, she still experienced significant anxiety during episodes.
• Weeks 5-8:
  • After beginning CBT, Sarah reported feeling more empowered to manage her symptoms. The therapist helped her develop coping strategies, which included exposure to her triggers in a controlled manner. She practiced relaxation techniques that helped her remain calm during episodes.
• Months 3-6:
  • Sarah noticed a marked improvement in her overall well-being. While she still experienced episodes of dizziness, they became less frequent and less severe. Her confidence increased, and she was able to return to some social activities and exercise, albeit with caution.
• Month 6:
  • At her six-month follow-up with the neurologist, Sarah reported that she was now managing her symptoms effectively. She was able to work full-time, engage in physical activities, and her anxiety had significantly decreased.

Conclusion

Sarah’s journey through chronic vertigo illustrates the complex nature of vestibular disorders and the importance of a multidisciplinary approach to treatment. With a combination of vestibular rehabilitation, cognitive behavioral therapy, and lifestyle modifications, she was able to manage her symptoms and improve her quality of life. This case underscores the need for ongoing support and follow-up for individuals dealing with chronic dizziness, as well as the effectiveness of addressing both the physical and psychological components of the condition.