Dizziness in elderly patients: discussion based on a clinical observation

Abstract

In elderly patients, vestibular disorders are often associated with concomitant diseases and lead to falls and injuries. When treating elderly patients, it is necessary to determine an underlying cause of dizziness, and assess concomitant diseases, medications taken and their possible impact on the course of the underlying disease. In elderly patients, vascular dizziness is often misdiagnosed, while peripheral causes of dizziness are not identified, and effective treatment is not provided. Early recognition and prompt treatment of acute dizziness are important to reduce the incidence of residual dizziness, especially in elderly patients at risk of falling. In this article, we present a case of an elderly patient with acute vestibular dizziness due to benign paroxysmal positional vertigo (BPPV) against a background of comorbid orthostatic hypotension. For a long time, the patient's vertigo was mistakenly recognized as a manifestation of cerebrovascular disease. The combination of peripheral vestibulopathy with orthostatic hypotension led to a fall and injury. Recognition and effective treatment of BPPV (Epley maneuver), elimination of hypotension by optimizing antihypertensive therapy and the use of Arlevert resulted in a sustained positive effect. The efficacy of Arlevret in elderly patients is discussed.

Keywords

• vertigo
• dizziness
• treatment
• vestibular suppressive therapy
• benign paroxysmal positional vertigo
• meniere's disease (syndrome)
• vestibular neuronitis
• polymorbidity
• dimenhydrinate
• cinnarizine
• arlevert
• vestibular rehabilitation