Case 01 · foundation
Sudden vertigo in a 42-year-old man
Vignette
A 42-year-old previously healthy man presents to the emergency department with 36 hours of continuous vertigo, nausea, and unsteadiness. He had a viral upper respiratory infection two weeks ago. On examination he has spontaneous left-beating horizontal-torsional nystagmus, a positive head impulse test to the right, no skew, no hearing loss. Bucket SVV reads +7.5° (tilted to the patient's right) with low trial-to-trial variability.
SVV trace
Large ipsilesional tilt, low variability