A 52-Year-Old Woman Is Brought to the Emergency Department Due

question 517

Multiple Choice

A 52-year-old woman is brought to the emergency department due to severe dizziness, unsteadiness, and nausea.  The spinning sensation began suddenly when the patient's head was tilted back and to the left while getting her hair washed at a salon.  When she tried to get out of the chair, she tilted to the left and was unable to sit upright without assistance.  She reports no similar symptoms in the past but recently had an upper respiratory illness.  Medical history includes hypertension and hyperlipidemia.  The patient is an active smoker with a 20-pack-year history and drinks alcohol occasionally.  Temperature is 37 C (98.6 F) , blood pressure is 144/90 mm Hg, and pulse is 92/min and regular.  On physical examination, the patient appears uncomfortable and keeps her eyes closed.  The pupils are equal and reactive, and nystagmus is present.  Impaired pinprick sensation is present on the left side of the face and right upper and lower extremities.  Deep tendon reflexes are normal throughout.  Which of the following is the most likely cause of this patient's current condition?

• A)Acute inflammation of the left vestibular nerve
• B)Dissection of the left vertebral artery
• C)Distension of the endolymphatic system
• D)Occlusion of the right middle cerebral artery branch
• E)Otolith dislodgment into the semicircular canal

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