A 34-year-old woman reports recurrent attacks of spinning vertigo lasting 15 to 30 minutes, several times monthly, provoked by sleep deprivation and flickering visual stimuli. She has a lifelong history of migraine with photophobia during the attacks. Audiometry and caloric tests are normal. The most likely diagnosis is:

• A Definite Meniere's disease
• B Persistent postural perceptual dizziness
• C Vestibular migraine ✓
• D Recurrent vestibular neuritis

Explanation

Vestibular migraine causes episodic vertigo lasting minutes to hours with a migraine history, migrainous features such as photophobia during attacks, and triggers including sleep deprivation and visual stimuli. Normal audiometry excludes Meniere's disease, which requires documented fluctuating sensorineural hearing loss. Persistent postural perceptual dizziness produces chronic, continuous dizziness aggravated by upright posture and motion, not discrete spontaneous vertigo attacks. Recurrent vestibular neuritis is rare and typically leaves residual unilateral hypofunction on caloric testing.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.