Document Type

Capstone Project

Publication Date

5-28-2021

First Advisor

Nicholas Stanley, Ph.D. Au.D.

Abstract

Case 1:

Introduction: One of the leading causes of centrally based vestibular impairment is a cerebrovascular accident (CVA). Patients typically present with limb or facial weakness, dizziness and imbalance, impaired vision, and speech or language dysfunction, however, these symptoms can vary depending on the site of lesion. Case presentation: An 85-year-old female presented with dizziness, bilateral tinnitus, aural fullness, and aphasia, occurring after she suffered a CVA. Three months after the CVA, she was seen by a balance clinic for a videonystagmography (VNG) and audiologic evaluation. Discussion: CVAs can alter the blood supply to the inner ear and its nerve support, leading to neurotologic symptoms. Consideration of the stroke location, like the AICA or PICA, can help lead to an accurate diagnosis and therapy recommendations. Conclusion: Magnetic resonance imaging is strongly encouraged for CVA patients presenting with dizziness. Locating the site of lesion before vestibular testing can provide better patient outcomes and recommendations.

Case 2:

Introduction: Vestibular Paroxysmia (VP) is a rare disease with symptoms such as episodic positional vertigo, tinnitus, and unilateral audiometric findings. Case presentation: A 68-year-old female reported to her local otolaryngologist with unilateral hearing loss in her right ear and vestibular symptoms. An MRI revealed VP, also known as a vascular loop, on her right side. Discussion: It is important to utilize a thorough case history in the diagnostic protocol for VP. An accurate case history and patient report can be the most important diagnostic tool in identifying the cause of symptoms. Conclusion: While diagnostic tests can at times definitively identify vestibular disorders, it is also important to consider the patient’s reported symptoms when investigating their dizziness. In this case study, an accurate and thorough case history helped lead to an MRI which identified VP when diagnostic tests could not.

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