What is the most likely diagnosis for a 32-year-old woman presenting with an 11-day history of vertigo, characterized by a sense of spinning, accompanied by unsteadiness, nausea, vomiting, and difficulty walking, which began shortly after the onset of a sore throat and ear fullness, with physical examination revealing end-gaze nystagmus?

Differential Diagnosis

• Single most likely diagnosis
  • E) Vestibular neuronitis: This is the most likely diagnosis given the patient's symptoms of vertigo, unsteadiness, and nausea that started after a sore throat and feeling of fullness in both ears. The presence of end-gaze nystagmus when gazing to the right also supports this diagnosis. Vestibular neuronitis is often preceded by a viral upper respiratory tract infection, which fits with the patient's history of a sore throat.
• Other Likely diagnoses
  • B) Benign paroxysmal positional vertigo: Although the patient's symptoms do not specifically mention positional vertigo, this condition is a common cause of vertigo and could be considered if the patient's symptoms were triggered by specific head movements.
• Do Not Miss
  • A) Acoustic neuroma (vestibular schwannoma): Although this is a less likely diagnosis given the patient's acute onset of symptoms and lack of hearing loss or tinnitus, it is a serious condition that could present with vertigo and should not be missed. However, acoustic neuromas typically cause gradual, progressive symptoms.
• Rare diagnoses
  • C) Meniere disease: This condition typically presents with a combination of vertigo, tinnitus, hearing loss, and aural fullness. The patient does not have tinnitus or hearing loss, making this a less likely diagnosis.
  • D) Presbycusis: This is age-related hearing loss and is not relevant to the patient's symptoms of vertigo and unsteadiness. The patient is also relatively young for presbycusis.