A 50-year-old man develops sudden severe vertigo with nausea, unable to stand, with no hearing loss and no neurological deficit. Head impulse test (HIT) shows a corrective saccade when the head is thrust towards the left. The most likely diagnosis is:

• A Left posterior inferior cerebellar artery (PICA) infarction
• B Left vestibular neuritis ✓
• C Left superior semicircular canal dehiscence
• D Acute left Meniere's attack

Explanation

A positive head impulse test (corrective catch-up saccade) towards the left indicates impaired left vestibuloocular reflex — consistent with left vestibular neuritis (peripheral hypofunction). Vestibular neuritis causes severe continuous vertigo with positive HIT and negative HINTS for central disease (no direction-changing nystagmus, no skew deviation, no acute hearing loss). PICA infarction is excluded by a negative HIT (the HINTS examination distinguishes central from peripheral), though some PICA strokes can mimic peripheral disease.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.