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Bilateral sequential peripheral vestibulopathy

A 61-year-old man presented to the emergency room with a 48-hour history of acute spontaneous vertigo without aural symptoms. Two years previously, he had 6 spells of spontaneous vertigo and tilt illusion lasting seconds within a 24-hour period. At that time, his examination, brain MRI, and CT angiography were normal. As a teenager, he had experienced posttraumatic migraine headaches for 4 years. His emergency room assessment revealed third-degree right-beating spontaneous nystagmus, a positive left horizontal head impulse, no skew deviation, and no cerebellar or long tract signs.