Acute Vestibular Neuritis With Unidirectional Nystagmus and Abnormal Video Head Impulse Test

𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is 45-year-old man who presented to the emergency department (ED) 2 days prior to this video recording with acute onset prolonged vertigo, nausea, head motion intolerance, unsteadiness and spontaneous nystagmus, consistent with the acute vestibular syndrome. Video-oculography examination in the ED demonstrated mixed left-beating and torsional (top poles beating toward left ear) nystagmus that was unidirectional (i.e., left-beating in all directions of gaze) and increased in left gaze in accordance with Alexander's law. There was no loss of hearing, video head impulse test was abnormal to the right (low gain and corrective saccades), and test of skew was normal (i.e., vertical alignment was normal with alternate cover test). Per the HINTS exam (Head Impulse, Nystagmus, Test of Skew) and in the absence of hearing loss, he was diagnosed with right-sided vestibular neuritis. He was given steroids and presented for follow-up 2 days later (the day of this recording). Nystagmus was much less intense than it had been in the ED, and symptomatically, he was much improved. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: This patient presented to the emergency department (ED) 2 days prior to the video recording with acute onset prolonged vertigo, nausea, head motion intolerance, unsteadiness and spontaneous nystagmus, consistent with the acute vestibular syndrome. Video-oculography examination in the ED demonstrated mixed left-beating and torsional (top poles beating toward left ear) nystagmus that was unidirectional (i.e., left-beating in all directions of gaze) and increased in left gaze in accordance with Alexander's law. There was no loss of hearing, video head impulse test was abnormal to the right (low gain and corrective saccades), and test of skew was normal (i.e., vertical alignment was normal with alternate cover test). Per the HINTS exam (Head Impulse, Nystagmus, Test of Skew) and in the absence of hearing loss, he was diagnosed with right-sided vestibular neuritis. He was given steroids and presented for follow-up 2 days later (the day of this recording). Nystagmus was much less intense than it had been in the ED, and symptomatically, he was much improved. https://collections.lib.utah.edu/ark:/87278/s6pg73w3