A 9-year-old male, with no significant past medical history, presents to the office with dizziness over 3 days. He reports sudden onset of a “queasy” feeling at bedtime. He then awoke from sleep with a “spinning” sensation, vomited, and felt off balance. Family reports that he looked pale during the episode and was unable to open his eyes due to the spinning sensation. Family was unable to evaluate for nystagmus. He vomited several times and then fell asleep. The next day he stayed in bed all day and continued to complain of a constant spinning sensation. By the following day, patient was off balance, but returned to school.

Patient denied tinnitus, hearing loss, headaches, blurred vision, nystagmus, loss of consciousness, frequent falls, weakness of the arms or legs, chest pain, light sensitivity, or noise sensitivity. He also has no history of seizures, head trauma, concussion, heart disease, or Chiari malformation. He showed third degree spontaneous nystagmus to the right, positive head impulse test to the left; post headshake revealed nystagmus to the right. He had normal strength and reflexes and no dysmetria or dysrhythmia on finger to nose or arm roll. He showed positive on a Fukuda stepping test to the right and unsteady Romberg’s test.

What is the most likely diagnosis?

Have you figured out this diagnosis? The correct answer is vestibular neuritis, the subject of the Spring 2018 issue’s cover article.


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