Clinical reasoning: a 55-year-old woman with vertigo. A dizzying conundrum.

Daniel R. Gold, DO Stephen G. Reich, MD SECTION 1 A 55-year-old woman presented to the emergency department complaining of dizziness. Several hours earlier she abruptly felt “the room spinning and moving back and forth.” Simultaneously, she experienced nausea, vomiting, and gait unsteadiness. The dizziness exacerbated with head movement. She denied head or neck pain, photophobia, phonophobia, auditory symptoms, weakness, numbness, diplopia, dysarthria, dysphonia, dysphagia, history of recent illness, prior dizziness, or headache. Medical history included hyperlipidemia and hypertension.