clinician · Clinical case

Case 2 — Vertical canal-only deficit

Vignette
A 51-year-old woman has 36 hours of moderate vertigo with nausea but is now able to walk with mild unsteadiness. There is no hearing loss. Examination shows subtle down-beat torsional nystagmus, slightly worse on right gaze. Bedside head impulse to the left lateral is normal. The treating clinician initially suspects a central lesion and orders MRI, which is normal. vHIT is then performed and shown below.

Six-canal vHIT

0100200R latg=0.930100200L latg=0.950100200R antg=0.880100200L antg=0.870100200R postg=0.860100200L postg=0.38

Audiogram

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

What is the most likely diagnosis?

References

  1. MacDougall HG, McGarvie LA, Halmagyi GM, Curthoys IS, Weber KP. The video head impulse test (vHIT) detects vertical semicircular canal dysfunction. PLoS One 2013;8:e61488.
  2. 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.
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