A 65 years old woman presents with a chief complaint of dizziness. She describes it as a sudden and severe spinning sensation precipitated by rolling over in bed onto her right side. Symptoms typically last <30 seconds. They have occurred nightly over the last month and occasionally during the day when she tilts her head back to look upward. She describes no precipitating event prior to onset and no associated hearing loss, tinnitus, or other neurologic symptoms. Otologic and neurologic examinations are normal except for the Dix-Hallpike maneuver, which is negative on the left but strongly positive on the right side. What are the most important differential diagnoses?

Of the relevant differential diagnoses, it is important to rule out cholesteatoma, Meniere’s disease, labyrinthitis and vestibular neuronitis.

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This post was written by Omar Rifai