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Vestibular Neuritis — RACP Adult Medicine MCQ

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EasyNeurologyVestibular NeuritisRACP Adult Medicine

A 45-year-old man presents with sudden onset of vertigo, nausea, and nystagmus after a viral URTI. Symptoms are constant and worsen with head movement. Romberg test shows falling towards the right. The head impulse test is positive (corrective saccade) when turning towards the right. Hearing is normal. What is the most likely diagnosis?

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Correct answer: B — Vestibular neuritis

Acute constant vertigo with positive head impulse test (corrective saccade towards the affected side), direction-fixed horizontal nystagmus, and no hearing loss is vestibular neuritis. It is caused by viral inflammation of the vestibular nerve. The positive HIT (peripheral pattern) helps exclude posterior circulation stroke (negative HIT = central cause). Treatment is supportive with vestibular rehabilitation.

Reference: eTG Neurology – 2024 – Acute Vertigo; HINTS Exam