The grocery-store dizziness — PPPD

PPPD is the diagnosis the normal tests were pointing at all along: the Bárány Society criteria name the pattern — persistent non-spinning dizziness on most days, worse upright and in moving or complex visual environments, precipitated by an illness or event that has recovered — and Popkirov’s review makes the two points a treating therapist needs: it is common, and it is treatable. The maintenance loop is threat appraisal plus avoidance, so the treatment is graded exposure and habituation with the anxiety addressed directly, in a CBT-informed frame, not another round of testing and not a daily suppressant. What you do with it: make the diagnosis on the criteria and say it out loud, build the exposure ladder from aisle one to the Saturday shop, keep the rehabilitation tailored to visual-motion sensitivity, and route escalating mood symptoms into the psychology pathway early.

• Any new focal sign, positional burst with latency or hearing change — the PPPD diagnosis does not retire the examination; repeat it
• Low mood or panic that is escalating — involve the psychology pathway early rather than at crisis

• Vertigo with a headache — vestibular migraineTier 2
• The walker just in case — fear of falling, deconditioningTier 1

This page carries the case’s first decision. The full sequence — every decision, the examination by domain, and the debrief that grades you — is in the drill, and the library is included with membership.