A 28-year-old presents with sudden onset severe vertigo, nausea, vomiting, and a horizontal nystagmus beating away from the left ear. Hearing is normal bilaterally and there are no neurological deficits. The Dix-Hallpike test is negative. What is the most likely diagnosis?

• A Acute vestibular neuritis affecting the left labyrinth ✓
• B Benign paroxysmal positional vertigo of the left posterior canal
• C Meniere's disease of the left ear
• D Acoustic neuroma of the left eighth nerve

Explanation

Acute vestibular neuritis presents with sudden severe vertigo, nausea, and vomiting due to sudden unilateral vestibular loss, most often following a viral upper respiratory infection. Nystagmus beats away from the affected (slower) side due to intact contralateral input. Hearing is characteristically preserved because the cochlear nerve is spared. A negative Dix-Hallpike rules out BPPV.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.