A 23-year-old graduate student experiences sudden dizziness after a recent viral URI. Which diagnosis is most likely?

• A. Meniere's disease
• B. Vestibular neuronitis
• C. Benign positional vertigo
• D. Vertebrobasilar insufficiency

Answer: (B)

Sudden, persistent vertigo after a recent viral URI points to vestibular neuritis, an acute peripheral vestibular disorder from inflammation of the vestibular nerve. It typically presents with abrupt onset vertigo that can last days, with accompanying nausea and gait imbalance, but the hearing is preserved. This contrasts with other causes where hearing loss or brief episodic vertigo is more characteristic: Meniere disease involves recurrent vertigo with fluctuating hearing loss and tinnitus; benign paroxysmal positional vertigo causes brief vertigo triggered by head position without sustained imbalance or hearing changes; vertebrobasilar insufficiency presents with focal neurologic symptoms (diplopia, dysarthria, ataxia) and occurs in patients with vascular risk factors. The preserved hearing and the post-viral onset make vestibular neuritis the most likely diagnosis in this scenario.