Neurolabyrithitis with Ny to the affected side

27yr old male with AVS (Acute Vestibular Syndrome) and aural fullness in the right ear which started three days ago.

ADG shows deaf right ear
Audiogram Neurolabyrinthitis
VHIT and Caloric test shows loss of vestibular function at the right side
NeurolabyrinthitisCaloric test Neurolabyrinthitis

Nothing would be so peculiar that he had Ny to the left. But he had Ny to the right !?! Nystagmus was present just without fixation.
It is possible to see nystagmus to the affected side but usually on the first day. But in this case it’s already third day and caloric test and VHIT demonstrate obvious vestibular asymmetry (right side deficient).

Also, what’s interesting he has BPPV on the right side also. Dix-Hallpike to the right resolved much stronger horizontal ny but without vertigo, but after latency of about 10sec vertigo has started and torsional ccw component added to spont ny. Epley.

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