Clinical case · clinician
Persistent dizziness six months after concussion
Vignette
A 28-year-old previously well teacher had a concussion playing recreational football 6 months ago. Acute symptoms (headache, photophobia, transient vertigo) resolved within 3 weeks. She now reports daily dizziness — a constant 'rocking' sensation, worse on screens, in crowded supermarkets, and at the end of the day. She has stopped attending crowded gatherings. Bedside examination is normal: no spontaneous nystagmus, normal head impulse test, normal smooth pursuit and saccades, normal Romberg. MRI of brain is normal. Audiometry is normal.
CDP findings
Single-best-answer
Which diagnosis best fits the clinical picture, and what supportive CDP finding is most likely?
Teaching point. PPPD frequently follows a triggering event including head injury, vestibular neuritis, or even a panic attack. The clinical picture — three or more months of motion- and visually-provoked unsteadiness — is the diagnosis; CDP supports it via visual preference and over-scaled MCT amplitudes. Treatment is multimodal: vestibular rehabilitation, cognitive-behavioural therapy, and (in some patients) low-dose SSRI medication.