Patient:  D.G.

Age: 47

The patient complains of dizziness, noticed mostly on turning her head to the right.  Sometimes this causes her to have a visual disturbance that she calls “blacking out”. She does not lose consciousness, only vision. She says it has happened when turning her head while driving.

She says she has in the past been diagnosed with BPPV, though not treated for it.

She has rotator cuff problems and neck problems.

She notices mild tinnitus, again more noticeable with head right, heard only in quiet environments.

Turning her head in the clinic did not provoke nystagmus nor any symtoms.  She was asked to extend her head backwards and turn to the right; this produced brief nystagmus which appeared horizontal.

• What does that suggest?