An unusual case of bilateral vestibulopathy, chronic subjective dizziness and spondyloarthropathy.

OBJECTIVE

Vertigo and dizziness are two common symptoms seen in everyday practice. However, in some cases, making a diagnosis can be challenging. This case report shows the relevance of a careful psychiatric history, which led to the diagnosis of chronic subjective dizziness associated with bilateral peripheral vestibulopathy.

METHODS

A case of a 33-year-old lady with multiple episodes of vertigo attack after a minor head injury is reported.

RESULTS

A comprehensive audiometric and vestibular evaluation reviewed bilateral peripheral vestibulopathy. The frequency of the vertigo attacks decreased after treatment with betahisdine, but the patient still experienced chronic dizziness. Interestingly, when she developed spondyloarthropathy (SpA) 2 years later, both the vertigo and dizziness disappeared. When the patient went into clinical remission for SpA, she once again felt the vertigo and dizziness. The symptoms were initially thought to be part of the autoimmune disease. However, a course of oral prednisolone was ineffective. She was later diagnosed with agoraphobia without panic attack and chronic subjective dizziness, and was successfully treated with a course of benzodiazepine.

CONCLUSION

The case presented demonstrates the importance of a biopsychosocial approach to patient management as vertigo and dizziness are often accompanied by psychological problems that must not be overlooked.