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Pediatric vertigo: Case studies

Pediatric Vertigo: Case Studies

Case Study 1: Benign Paroxysmal Vertigo of Childhood (BPVC)

Patient Profile:

• Name: Emily Roberts
• Age: 7 years
• Gender: Female
• Medical History: Healthy; no significant past medical history.

Initial Presentation:
Emily was brought to the pediatric clinic by her parents, who reported that she had experienced several episodes of dizziness over the past few months. The episodes were brief, typically lasting less than a minute, and often occurred when she rolled over in bed or turned her head quickly.

Evaluation:

• A thorough history and physical examination were conducted.
• Neurological examination was normal, and there were no signs of hearing loss.
• The Dix-Hallpike maneuver was performed, which induced vertigo and nystagmus, confirming the diagnosis of Benign Paroxysmal Vertigo of Childhood (BPVC).

Treatment:

• Parents were educated about the benign nature of the condition and reassured that episodes would likely resolve over time.
• Emily was advised to avoid sudden head movements when possible.

Outcome:
At a follow-up visit three months later, Emily’s episodes had decreased significantly. Her parents reported that she had returned to normal activities without further dizziness. BPVC is often self-limiting, and in this case, the prognosis was excellent.

Case Study 2: Vestibular Neuritis

Patient Profile:

• Name: Jacob Thompson
• Age: 12 years
• Gender: Male
• Medical History: No significant medical history; recent upper respiratory infection.

Initial Presentation:
Jacob presented to the emergency department with sudden-onset vertigo, severe nausea, and vomiting that began the day prior. He had a history of a recent viral upper respiratory infection. He was unable to walk without assistance due to dizziness.

Evaluation:

• Neurological examination was unremarkable, with no focal deficits noted.
• Audiometric testing showed normal hearing, ruling out middle ear pathology.
• The diagnosis of vestibular neuritis was made based on clinical presentation and history of recent viral infection.

Treatment:

• Jacob was treated with vestibular suppressants (meclizine) and antiemetics to manage nausea.
• He was referred for vestibular rehabilitation therapy once his symptoms stabilized.

Outcome:
After one week, Jacob’s symptoms began to improve. He completed a course of vestibular rehabilitation therapy, which helped him regain balance and confidence. By the three-month follow-up, he reported complete resolution of symptoms and was able to return to school and sports.

Case Study 3: Migrainous Vertigo

Patient Profile:

• Name: Sophie Martinez
• Age: 15 years
• Gender: Female
• Medical History: History of migraines since age 10; episodes of headache associated with nausea.

Initial Presentation:
Sophie visited the clinic for recurrent episodes of vertigo associated with her migraines. The dizziness often preceded or followed her migraine attacks and was accompanied by sensitivity to light and sound.

Evaluation:

• A detailed history confirmed that her vertiginous episodes coincided with her migraine days.
• Neurological examination showed no abnormalities.
• The diagnosis of migrainous vertigo was established based on her history of migraines and associated symptoms.

Treatment:

• Sophie was placed on a preventive migraine medication (topiramate) to reduce the frequency of migraine attacks and, subsequently, the vertiginous episodes.
• She was also educated on identifying migraine triggers and was advised to maintain a headache diary.

Outcome:
Over the next six months, Sophie experienced a significant reduction in the frequency of both migraine and vertigo episodes. At her follow-up visit, she reported improved quality of life and engagement in school activities without the disruptive impact of dizziness.

Case Study 4: Inner Ear Anomaly

Patient Profile:

• Name: Noah Wilson
• Age: 9 years
• Gender: Male
• Medical History: Recurrent ear infections in childhood; no significant issues.

Initial Presentation:
Noah’s parents brought him to the clinic due to concerns about persistent dizziness and balance issues that had developed over the past year. He also experienced difficulty hearing and occasional tinnitus.

Evaluation:

• Audiometric testing revealed a conductive hearing loss.
• A CT scan of the temporal bone was performed, showing a congenital anomaly of the inner ear affecting vestibular function.

Treatment:

• Noah was referred to an otolaryngologist for further evaluation and management options.
• Surgical intervention to address the structural anomaly and improve hearing was considered.

Outcome:
After surgical correction of the inner ear anomaly, Noah’s balance improved significantly, and his hearing was restored to normal levels. At follow-up, he reported no further episodes of dizziness, allowing him to participate fully in physical activities and sports.

Conclusion

These case studies highlight the diverse causes of vertigo in pediatric patients, ranging from benign conditions like BPVC to more complex issues such as vestibular neuritis and inner ear anomalies. Timely diagnosis and appropriate management are crucial in addressing vertigo in children, allowing them to maintain normal activities and improve their quality of life. Each case underscores the importance of a thorough evaluation to identify underlying causes and develop tailored treatment plans.

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