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Case 12
A 65 year-old man comes to the office with dizziness for several months. Closer questioning reveals that
he has had very brief (seconds) episodes where “it feels like Iʼm on a ship.” These episodes have
awakened him from sleep and he has also had them while washing his hair in the shower or looking over
his shoulder while backing up his car. There is no history of head trauma and no tinnitus, hearing loss or
associated visual, motor or sensory symptoms. He feels fine between episodes.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? How would you
monitor his condition and its treatment? What is the prognosis?

Case 12
A 65 year-old man comes to the office with dizziness for several months. Closer questioning reveals that
he has had very brief (seconds) episodes where “it feels like Iʼm on a ship.” These episodes have
awakened him from sleep and he has also had them while washing his hair in the shower or looking over
his shoulder while backing up his car. There is no history of head trauma and no tinnitus, hearing loss or
associated visual, motor or sensory symptoms. He feels fine between episodes.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? How would you
monitor his condition and its treatment? What is the prognosis?

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