Vertigo Disease : Case Presentation

Case presentation

The 49-year-old female patient presented with a long history of vertigo with nausea and ‘head fog’. The symptoms were intermittent over five years with an increase in severity over a recent twelve months. She was treated with antinausea medication during this time. Her previous blood pathology and brain imaging studies were unequivocal. She was employed in a managerial position with travelling. Her worsening symptoms were impacting her concentration and performance both socially and mentally.

Treatment plan. 

Vertigo is a very complex disorder. The complexity surrounds the various potential etiologies and thus create a challenge for clinicians. As such an inexperienced clinician can determine a generic diagnosis and therefore create ‘cookie cut’ therapy plans, which inevitably leads to the detriment of the patients health.

This lady had a unique form of vestibular hypo-function (ICD H81.9). She had Benign Paroxysmal Positional Vertigo (BPPV) with aberrant saccule activation. Some key findings include;

1. Dizziness Handicap Inventory (DHI) score-50% (mild dizziness) 
2. Modified Falls Efficiency Score (MFES) - 50% (poor efficiency) 
3. Hypo metric saccades 
4. Dynamic Visual Acuity (DVA) test poorly with vertical activity 
5. Ataxic dynamic gait with vertical head translation
 6. Computerised Digital Posturography (CDP) - low balance confidence score 
7. Vertical body/trunk movements provoke nausea 
8. Dix-Hall Pike test was unequivocally for nystagmus and nausea.

Giving this presentation, the practitioners therapeutic goals were: 

  • To improve this patient’s impairment rating for vertigo and dizziness. 
  • To improve her dynamic balance control. 
  • To actively support skills to better adapt her disability in a social setting.

Clinical outcome.

After 12 weeks of therapy, the patient had improved with no further nausea or vertigo. The effective treatment involved Vestibular Rehabilitation Therapy (VRT). The vertigo was treated with specifically moderated routines with a combination of head and eye activities to support the balance function. VRT is a safe therapy enabling habituation of vestibular control. For more information follow the link,

She had significant functional improvements with standard outcome measures (DHI score, MFES, and DVAS scores) and VOR function was full in all vertical planes. The ladies BPPV with saccule failure was corrected, and she returned to a full ADL.

More reading

 Baloh RW, Kerber K: Clinical Neurophysiology of the Vestibular System. 4th ed, 2010. Furman JM, Cass SP, Whitney SB. Balance Disorders A Case Study Approach to Diagnosis and Treatment, 2010. Herdman SJ. Vestibular Rehabilitation 3rd edition. 2007 Jacobson GP, Shepard NT: Balance Function Assessment and Management. 2007 Leigh RJ, Zee DS. The Neurology of Eye Movements. 4th eds. New York, NY: Oxford Univ Press Inc; 2006. Badke MB, Miedaner JA, Shea TA, et al.: Effects of vestibular and balance rehabilitation on sensory organization and dizziness handicap. Ann Otol Rhinol Laryngol 2005 Jan; 114(1 Pt 1): 48-54 Brown KE, Whitney SL, Wrisley DM, and Furman JM. “Physical therapy outcomes for persons with bilateral vestibular loss.” Laryngoscope 111(10): 1812-7, 2001. Brown KE, et al. Physical therapy for central vestibular dysfunction. Arch Phys Med Rehabil. 2006 Jan;87(1):76-81. Cass S, Borello-France D, Furman J. Functional outcome of vestibular rehabilitation in patients with abnormal sensory organization testing. Am J Otol. 1996;17:581–594.

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Vertigo Disease : Case Presentation