Practice

1. Which findings are prominent here?

Tick every finding that you consider clinically prominent in this vignette.

• Cervical trigger
  Symptoms reliably reproduced by specific neck positions or movements; head-on-trunk provocation increases dizziness.
• Visual dependence
  Symptoms substantially worse in busy visual environments — supermarkets, traffic, crowds, scrolling screens.
• Episodic discrete attacks
  Discrete bouts of moderate-to-severe vestibular symptoms with well intervals in between; not continuous.
• Migraine features
  Photophobia, phonophobia, throbbing headache, aura, or other migrainous accompaniments around the episodes.
• Positional spinning
  Brief (<60s) spinning vertigo on specific head positions — lying down, rolling in bed, looking up.
• Autonomic prominence
  Nausea, pallor, sweating, or palpitations dominate the experience over the sense of motion itself.
• Brainstem features
  Diplopia, dysarthria, perioral numbness, drop attacks, or sudden 'unwell' feeling on a stereotyped trigger.