American Board of Internal Medicine (ABIM) Certification Practice Exam

What condition is characterized by acute, severe, and persistent nonpositional peripheral vertigo following a viral infection?

1. Benign paroxysmal positional vertigo

2. Meniere's disease

3. Vestibular neuronitis

4. Labyrinthitis

The correct answer is: Vestibular neuronitis

The condition characterized by acute, severe, and persistent nonpositional peripheral vertigo following a viral infection is vestibular neuronitis. After a viral illness, such as an upper respiratory infection, the vestibular system can become inflamed, leading to intense vertigo. This condition typically presents with a sudden onset of severe vertigo that is not triggered by head position changes, which distinguishes it from conditions like benign paroxysmal positional vertigo, where vertigo is triggered by specific head movements. The nature of the vertigo in vestibular neuronitis is often prolonged, lasting days to weeks, and is accompanied by balance difficulties, though auditory symptoms are usually absent, helping differentiate it from labyrinthitis, which can involve hearing loss and symptoms reflecting both vestibular and auditory system involvement. Meniere’s disease, on the other hand, includes episodes of vertigo accompanied by hearing changes and tinnitus, which is not the case in vestibular neuronitis. Therefore, the accurate identification of vestibular neuronitis is crucial, particularly in the context of a recent viral infection, as it directly addresses the specific clinical presentation described in the question.