Patient Alias: Karen Age: 21 Sex: Female Occupation: University Student Abstract Persistent Postural-Perceptual Dizziness (PPPD) is a chronic functional vestibular disorder that is often triggered by an acute vestibular insult. This paper presents the case of a 21-year-old female who developed debilitating chronic dizziness following a viral labyrinthitis episode. Diagnosis was made using the Bárány Society diagnostic criteria, and treatment involved a combination of vestibular rehabilitation therapy (VRT), cognitive behavioral therapy (CBT), and selective serotonin reuptake inhibitors (SSRIs). The case highlights the importance of early recognition of PPPD in young adults to prevent academic and social disability. 1. Introduction PPPD is not a structural or psychiatric disease per se , but a maladaptive brain response to a balance threat. It is the most common cause of chronic vestibular syndrome in adults aged 20–50. In patients under 25, PPPD is often misdiagnosed as anxiety or "psychogenic dizziness," delaying effective treatment. 2. Case Presentation History of Presenting Illness: Karen, a 21-year-old university student, presented with a 6-month history of persistent dizziness. Symptoms began immediately after an acute episode of vestibular neuritis (confirmed by a positive head impulse test and nystagmus). While the acute vertigo resolved within 72 hours, she developed a persistent sensation of swaying, rocking (not spinning), and unsteadiness that worsened when standing, walking, or exposed to moving visual stimuli (e.g., scrolling on her phone, walking through a supermarket aisle).
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