Case 14 · foundation

Continuous vertigo for two days with no hearing loss

Vignette

A 38-year-old man presents with two days of continuous spinning vertigo, severe nausea, and inability to walk without support. He had a cold the week before. Examination shows spontaneous left-beating horizontal nystagmus, a positive head impulse test to the right, no skew deviation, and normal hearing on both sides. Bucket SVV is +6° (tilted to his right) with low variability.

SVV trace

SVV finding

Moderate ipsilesional tilt — classical peripheral pattern

Which feature most supports a peripheral rather than central cause?

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