This case involves a 48-year-old man who presented to his ENT with dizziness and vertigo. The following week, the ENT ordered a CT scan of the brain with contrast which was read as normal. Following the CT scan, the ENT diagnosed him with labrynthitis and assured him it should go away on its own. However, over the course of 4 months, the patient’s condition continued to decline so he decided to see another ENT. The second ENT noted that the patient had abnormal eye movement. She ordered a CT scan but it was again interpreted as normal, so she diagnosed him with positional vertigo and instructed him to go to canalith repositioning therapy as treatment. Two years after the patient’s initial visit to his first ENT, the patient reported that his symptoms had dramatically worsened. He was experiencing severe headaches, dizziness, impaired balance, and blurred vision. The ENT ordered an MRI of the brain which revealed a mass involving the cerebellum. The patient underwent emergency surgery to excise the mass which was revealed to be high grade cerebral cancer. Despite the surgery, the patient was left with profound neurological deficits, and can no longer walk independently.
Question(s) For Expert Witness
- 1.How often do you see/treat patients with dizziness and vertigo?
- 2.What follow up/work up is required when a patient presents repeatedly with worsening vestibular symptoms?
- 3.What is the differential diagnosis for such complaints?
- 4.Have you ever lectured/published on this subject?
Expert Witness Response E-004790
I treat patients with dizziness and vertigo every week. MRI with contrast needs to be ordered for patients such as the one in this case. The symptoms presented could be from the brain, neck, ear or eye. It could be benign paroxysmal positional vertigo, an acoustic neuroma, aneurysm, displaced ear crystals, cancer in the base of the skull among other causes. I have lectured on this topic.
Expert Witness Response E-090559
I see and treat patients with dizziness and vertigo every day. When a patient presents repeatedly with worsening vestibular symptoms, the patient would need an MRI of the brain with contrast and neurology consultation should be made. The differential diagnosis of such complaints would be benign paroxysmal positional vertigo (BPPV), brain tumor, multiple sclerosis (MS), acoustic neuroma/vestibular schwannoma, stroke/vascular issues or vestibular neuronitis/labyrinthitis.