Interplay of Vestibular Symptoms and Intracranial Hypertension: A Diagnostic Challenge in a Patient With Tullio's Phenomenon and Elevated Intracranial Pressure

This case report describes a 45-year-old Hispanic female with a history of hypertension who presented with persistent, debilitating dizziness exacerbated by loud noises that began approximately two weeks ago. She was initially misdiagnosed with sinusitis and treated with antibiotics and decongestants for 10 days. A comprehensive neurological evaluation, including vestibular evoked myogenic potential (VEMP) testing and magnetic resonance imaging (MRI), revealed findings consistent with benign paroxysmal positional vertigo (BPPV) and a possible component of superior semicircular canal dehiscence (SSCD). MRI also raised concern for intracranial hypertension, with evidence of optic nerve tortuosity, a partially empty sella turcica, and papilledema confirmed with fundoscopy. Audiologic testing indicated left-sided mild sensorineural hearing loss, and the Dix-Hallpike maneuver confirmed positional vertigo. The patient experienced marked symptom relief following vestibular rehabilitation. This case underscores the importance of a thorough diagnostic workup and individualized treatment strategy in patients with complex vestibular presentations. Further evaluation with high-resolution computed tomography and ophthalmologic consultation is recommended to confirm the underlying pathology and guide ongoing care.