Q: I am 35 years old suffering from severe vertigo, when I sit up from lying down or change my position. I don't have hearing loss or tinnitus and no nystagmus during the attack or nausea. But I become pale and fall from a height. After the attack ends, I feel exhausted. The neurological exam states that everything is normal, all vital signs are normal. An ear exam also suggests that everything is normal including audiometry. All other investigations are also normal like fasting blood sugar, CT scan of head, MRI of neck etc. The problem is getting worse day by day. I take medication and also try rehabilitation, but without benefit. Is this due to a convulsion or vertigo?

A:If neurological examination is normal, including CT and MRI then chances are that you have positional vertigo of peripheral origin. Prolonged anti-vertiginous (labyrinthine sedatives) tend to prolong the recovery. Adaptation exercises help. You need to see a neuro otologist who can assess the nature of the positional vertigo. If it is Benign paroxysmal positional vertigo then manoeuvres like Epleys proformed by the ENT doctor help. If it is a transient vertigo occurring in all change of positions then carbamazapine is reported to help these patients. Cardio consultation to rule out cardiac cause or orthostatic hypotension should also be done.