A 65-year-old hypertensive male presents with acute onset vertigo, vomiting, inability to stand, dysarthria and diplopia. There is no hearing loss. Nystagmus is direction-changing and not suppressed by fixation. The most likely diagnosis is:
- A Acute labyrinthitis
- B Lateral medullary (Wallenberg) syndrome ✓
- C Meniere's disease
- D Benign paroxysmal positional vertigo
Correct answer: B. Lateral medullary (Wallenberg) syndrome
Explanation
The triad of acute vertigo without hearing loss, combined with brainstem signs (dysarthria, diplopia, inability to stand), direction-changing nystagmus not suppressed by fixation, in an elderly hypertensive, points to central vestibular pathology — specifically Wallenberg syndrome (lateral medullary infarction from PICA territory). Labyrinthitis causes severe vertigo with hearing loss. BPPV is positional and lacks brainstem signs. Meniere's disease has episodic pattern with auditory symptoms.
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.