Clinical case · trainee

Eight-year-old with delayed motor milestones and falls

Vignette

An eight-year-old girl is referred by her paediatrician for evaluation of unsteadiness, falls on uneven surfaces, and difficulty riding a bicycle. She had bacterial meningitis at 18 months of age. Her parents report that she walks unsteadily in the dark and clings to the railing on stairs. Examination shows a positive Romberg test, bilateral abnormal head impulse responses, and a wide-based gait. Audiometry shows severe bilateral sensorineural hearing loss. Caloric testing is technically challenging but shows bilaterally reduced responses. CDP can be performed in age-appropriate equipment.

CDP findings

SOT pattern vs normal

MCT — medium-amplitude backward translation

ADT — sway energy across five trials per direction

Audiometric findings

Bilateral vestibulopathy after meningitis — severe bilateral sensorineural loss.

Bacterial meningitis is a classical cause of combined bilateral vestibulopathy and severe bilateral sensorineural hearing loss — both labyrinths are damaged by the same inflammatory or ischaemic process. The audiogram and CDP each document a severe deficit; together they argue for aggressive audiological habilitation (cochlear implantation candidacy) alongside vestibular rehabilitation.

Single-best-answer

Given the clinical picture and CDP findings, what is the most likely diagnosis and the most appropriate management priority?

Teaching point. Bacterial meningitis is a recognised cause of paediatric bilateral vestibulopathy, often producing concomitant severe sensorineural hearing loss. The CDP pattern in children mirrors that in adults — severe C5/C6 reduction with falls — but rehabilitation is more effective because of greater plasticity. Early intervention with audiological habilitation and vestibular rehabilitation can substantially improve outcomes.