Acute Labyrinthitis — SCE Neurology MCQ

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ModerateHeadache & Facial PainAcute LabyrinthitisSCE Neurology

A 40-year-old woman presents with acute vertigo, nausea, and hearing loss affecting the left ear. She has left-beating horizontal nystagmus that is suppressed by visual fixation. Head impulse test shows a corrective saccade on leftward head thrust. There are no cerebellar signs. What is the most likely diagnosis?

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Correct answer: D — Acute labyrinthitis

Acute labyrinthitis presents with acute vertigo (like vestibular neuritis) PLUS unilateral hearing loss and/or tinnitus, indicating involvement of both the vestibular and cochlear components of the inner ear. A positive head impulse test (corrective saccade on turning towards the affected side) indicates a peripheral vestibular lesion. Nystagmus suppressed by visual fixation also supports a peripheral cause. A: Vestibular neuritis does not cause hearing loss. C: Cerebellar infarction has a normal HIT and nystagmus not suppressed by fixation. D: BPPV is positional and brief. E: Ménière has recurrent episodes with aural fullness.

Reference: ABN/ACNR Acute Vertigo Guidelines; Strupp & Brandt Vestibular Review