A 62-year-old man had a sudden onset of dizziness, vertigo, imbalance, and blurred vision after suddenly turning his head to the right. This was followed by nausea and diaphoresis. The episode lasted for 12 hours.

Our patient had acute onset of vertigo and imbalance upon suddenly turning in bed with his head to the right side. The episode lasted 12 hours. He also had nausea and diaphoresis. He had no prior upper respiratory infection or flulike illness and did not complain of auricular pain, hearing loss, tinnitus, aural fullness, emesis, headaches, diplopia, dysarthria, facial paresthesias, extremity weakness, clumsiness, or numbness. He had no lateropulsion. He did not have orthostatic hypotension or evidence of a vesicular rash in the external auditory canal and concha. There was no history of motion intolerance during car, boat, or air travel. He was initially diagnosed as having presyncope versus syncope, and extensive cardiac investigations were unremarkable.

Balance involves the overlapping function of the visual, proprioceptive, and vestibular systems. Vertigo is defined as an illusion of movement either of self or the environment. Our patient had an acute vestibular syndrome characterized by severe vertigo, nausea, and postural instability. As Neurology was not consulted at the time of presentation, we cannot comment as to the possible presence of spontaneous nystagmus. When an acute vestibular syndrome evolves over days in an otherwise healthy patient, it is often attributed to a viral vestibular neuritis (vestibular neuronitis). If there is associated hearing loss, it is often attributed to a neurolabyrinthitis.

Vestibular neuritis refers to a disorder of the vestibular system without associated hearing loss, characterized by sudden attacks of severe vertigo, nausea, vomiting, and abnormal vestibular function on caloric testing in otherwise healthy patients. An upper respiratory infection often precedes this condition. The vertigo usually resolves within a week. Viral labyrinthitis is characterized by acute onset of severe and often incapacitating vertigo and hearing loss, frequently associated with nausea and vomiting. The vertigo usually resolves over several days to weeks. Bacterial labyrinthitis is rare in the postantibiotic era.