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Patient Description

A 22-year-old female has been experiencing daily dizziness described as a boat rocking sensation, rated up to 7/10 in severity, which sometimes improves with rest. She has had vertigo spells almost daily for three months, but these have not occurred in the last two months. Additionally, she reports unilateral pupil dilation during episodes of feeling unwell, hearing loss in the right ear confirmed by a hearing test, constant tinnitus in the same ear, and migraines with aura, sensitivity to light and sound. She also experiences muscle spasms at the bottom of her ribs and has been diagnosed with PCOS and asthma. She is currently taking Metformin extended release 500mg daily and Nurtec 75mg as needed for migraines. No known allergies to medications, but she has allergies to cats and dogs.

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Arora's Assessment

What might be happening

Based on the information you have provided, possible diagnoses include:

  • Meniere's Disease: This is a condition of the inner ear that can cause vertigo (a spinning sensation), tinnitus (ringing in the ear), hearing loss, and a feeling of fullness or congestion in the ear. Meniere's disease usually affects only one ear.

    • Treatment typically involves a combination of medications, lifestyle changes, physical therapy, and sometimes surgery.
  • Vestibular Migraine: This is a type of migraine that may or may not cause a headache, but can cause dizziness, problems with balance, and other symptoms. The dizziness and balance problems can be severe enough to cause problems with standing and walking.

    • Treatment typically involves medications to treat and prevent the migraines, as well as lifestyle changes to avoid triggers.
  • Benign paroxysmal positional vertigo (BPPV): This is a condition characterized by brief episodes of mild to intense dizziness. Symptoms are triggered by specific changes in the position of your head, such as tipping your head up or down, and by lying down, turning over or sitting up in bed.

    • Treatment typically involves a series of movements you can do at home to help dislodge the tiny particles from the semicircular canals.
  • Anisocoria: This is a condition characterized by an unequal size of the eyes' pupils. A slight difference in pupil size is normal for many people. However, a more noticeable difference can be a sign of a neurological issue.

    • Treatment depends on the cause. If an underlying condition is found, treatment will focus on that condition.

Please note that these are potential diagnoses based on the symptoms you've described. Only a healthcare provider can provide a definitive diagnosis.

What you can do

  1. Keep a symptom diary: Note down when your symptoms occur, what you're doing at the time, and what foods you've eaten that day. This can help identify any patterns or triggers to your symptoms.
  2. Stay hydrated: Dehydration can make symptoms of vertigo and migraines worse.
  3. Limit caffeine and alcohol: These can trigger migraines and vertigo in some people.
  4. Regular exercise: This can help reduce symptoms of vertigo and migraines.
  5. Consult a healthcare provider: They can provide a definitive diagnosis and appropriate treatment.

What you should look out for

Seek immediate medical attention if:

  • Your symptoms worsen or don't improve
  • You experience new symptoms, such as double vision, difficulty speaking, or severe balance problems
  • You have a severe headache unlike any you've had before

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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9 mo ago

Top picked over-the-counter products for BPPV (Benign Paroxysmal Positional Vertigo)

People Also Ask


What are the common symptoms of Meniere's Disease?

Common symptoms of Meniere's Disease include vertigo, tinnitus, hearing loss, and a feeling of fullness or congestion in one ear. These symptoms can vary in intensity and frequency.


How can vestibular migraines be managed or treated?

Vestibular migraines can be managed with medications to treat and prevent migraines, lifestyle changes to avoid known triggers, and sometimes physical therapy to help with balance issues.


What is benign paroxysmal positional vertigo (BPPV) and how is it treated?

Benign paroxysmal positional vertigo (BPPV) is characterized by brief episodes of dizziness triggered by changes in head position. It is often treated with specific head movements, known as the Epley maneuver, to help dislodge particles from the inner ear.


What could cause one pupil to be larger than the other (anisocoria)?

Anisocoria, or unequal pupil sizes, can be caused by a variety of factors including normal physiological differences, eye injuries, or neurological conditions. Treatment depends on the underlying cause, and a healthcare provider can help determine the appropriate approach.


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