Acute Vertigo in a 45-Year-Old Female

Keywords: Vestibular Neuritis, Acute Vertigo, Nystagmus, Imbalance, Viral Infection, Corticosteroids, Vestibular Rehabilitation.

Case Presentation

A 45-year-old female presented to the emergency department with a sudden onset of severe rotary vertigo, lasting for 8 hours. She described the sensation as "the room spinning" and was accompanied by nausea and vomiting. The patient reported a recent history of an upper respiratory tract infection one week prior. She denied any hearing loss, tinnitus, or focal neurological deficits. She had no significant past medical history and was not on any regular medications.

Clinical Examination

On examination, the patient exhibited nystagmus that was horizontal and torsional, with the fast phase beating toward the unaffected right ear. The head impulse test was positive on the left side, indicating a peripheral vestibular lesion. Romberg test showed a tendency to fall toward the left. Gait assessment revealed severe imbalance and a wide-based stance. Dix-Hallpike maneuver was negative for benign paroxysmal positional vertigo. Otoscopic examination was normal.

Diagnosis and Etiology

The clinical diagnosis was Vestibular Neuritis (acute peripheral vestibulopathy). The likely cause was a viral infection, given her recent upper respiratory symptoms and the absence of other underlying pathology. Vestibular neuritis typically results from inflammation of the vestibular nerve, often triggered by herpes simplex virus or other viral agents.

Management and Treatment

The patient was treated with corticosteroids (oral prednisone 60 mg tapering over 10 days) to reduce inflammation of the vestibular nerve. Symptom relief was achieved with vestibular suppressants (meclizine 25 mg three times daily) for the first 48 hours, and antiemetics as needed. She was advised to avoid driving and operating heavy machinery. After the acute phase, she was referred for vestibular rehabilitation therapy to promote central compensation and improve balance.

Outcome and Follow-Up

Within one week, the patient's vertigo resolved substantially, though mild imbalance persisted during rapid head movements. At the four-week follow-up, she had made a near-complete recovery. Serial balance assessments showed improvement in gait stability. The use of corticosteroids in combination with early vestibular rehabilitation is associated with better outcomes in Vestibular Neuritis.

Key Takeaways

• Vestibular Neuritis presents with acute, prolonged vertigo without hearing loss.
• Nystagmus is unidirectional (fast phase toward the unaffected ear).
• Positive head impulse test is a hallmark sign.
• Treatment includes corticosteroids and symptomatic management.
• Early vestibular rehabilitation is crucial for long-term balance recovery.