trainee · Clinical case

Case 1 — Sudden vertigo, no hearing loss

Vignette
A 38-year-old man wakes with severe spinning vertigo, vomiting, and unsteadiness. There is no headache and no hearing change. Examination shows left-beating horizontal-torsional spontaneous nystagmus that intensifies on left gaze. Bedside head impulse to the right is abnormal. Test of skew is negative. MRI is normal.

Six-canal vHIT

0100200R latg=0.320100200L latg=0.960100200R antg=0.400100200L antg=0.890100200R postg=0.840100200L postg=0.86

Audiogram

2505001k2k4k8k020406080100120Frequency (Hz)Hearing level (dB HL)○ right× left

What is the most likely diagnosis?

References

  1. Strupp M, Bisdorff A, Furman J, Hornibrook J, Jahn K, Maire R, Newman-Toker D, Magnusson M. Acute unilateral vestibulopathy/vestibular neuritis: diagnostic criteria — consensus document of the Bárány Society. Journal of Vestibular Research 2022;32:389–406.
  2. Manzari L, Burgess AM, MacDougall HG, Curthoys IS. Vestibular function after vestibular neuritis. International Journal of Audiology 2013;52:713–8.
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