A 45-year-old man presents to the clinic with a 3-day history of sudden onset vertigo, nausea, and imbalance. He reports that the vertigo started abruptly one morning while he was getting out of bed. The dizziness is described as a spinning sensation that worsens with head movement and does not improve with resting. He denies hearing loss, tinnitus, or a recent history of upper respiratory infections. He also denies any trauma or recent neurological symptoms.

On examination, he is noted to have spontaneous horizontal nystagmus that beats toward the right. The rest of his neurological exam, including cranial nerves and motor strength, is unremarkable. His gait is unsteady, and he is unable to perform the Dix-Hallpike maneuver due to severe dizziness.

The patient’s symptoms suggest vestibular neuritis, a condition characterized by inflammation of the vestibular nerve, typically caused by a viral infection. There is no involvement of the cochlear nerve, hence the absence of hearing loss.

The patient is advised to take symptomatic treatment with vestibular suppressants (e.g., meclizine) for the acute phase. Vestibular rehabilitation exercises are recommended once the acute symptoms resolve. Prednisone therapy is considered if the diagnosis of vestibular neuritis is confirmed.

The patient is advised to follow up in one week for symptom reassessment and evaluation of the need for further treatment.