Clinical case · clinician
Chronic dizziness exacerbated by busy visual environments
Vignette
A 34-year-old graphic designer was diagnosed with vestibular neuritis 14 months ago. Her acute symptoms resolved within three weeks, but she has had persistent daily dizziness for over a year, worse in supermarkets, on scrolling screens, and in crowds. She avoids these settings. Examination is normal — no spontaneous nystagmus, normal head impulse test, normal caloric testing. MRI is normal. The dizziness is described as a 'non-spinning unsteadiness and rocking sensation', present on most days, exacerbated by upright posture, motion, and complex visual stimuli.
CDP findings
Single-best-answer
Which Bárány Society diagnostic criterion is reflected in this presentation, and what CDP finding would support it?
Teaching point. PPPD is a clinical diagnosis (Bárány Society 2017). CDP is supportive, not diagnostic: the classic supporting feature is visual preference, reflecting hyper-reliance on vision. MCT amplitudes may also be exaggerated. The disorder is often triggered by a prior acute vestibular event and persists by maladaptive postural-control strategies.