The Clinical Problem Solvers Episode 452: The Clinical Unknown Series – Young lady with dizziness
Mar 27, 2026
A puzzling case of month-long spinning vertigo in a young woman leads to a hunt between vestibular and cerebellar causes. Normal imaging and mixed lab findings push the team toward autoimmune and gluten-related explanations. The story follows diagnostic tests, therapeutic trials, and a surprising diet-linked recovery.
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Use Timing Triggers And Targeted Exam For Dizziness
- Use the TIN-TRE approach for dizziness evaluation focusing on timing, triggers, and a targeted exam.
- Dr. Mark recommends distinguishing episodic vs persistent vestibular syndromes and performing a HINTS exam to separate central from peripheral causes.
Truncal Ataxia Points Toward Cerebellar Disease
- Cerebellar signs like truncal ataxia and dysmetria localize strongly to the cerebellum and raise concern for central causes.
- Mark emphasized that truncal ataxia implies central (cerebellar) pathology rather than peripheral neuropathy.
Medical Student Memory Of Cerebellar Hemorrhage
- Mark recounted a medical school case where a patient with sudden truncal ataxia had a massive cerebellar hemorrhage on CT.
- The story illustrated how truncal instability and vomiting can herald life-threatening cerebellar lesions.