Vestibular schwannoma presenting as vestibular neuritis-like attack during the COVID-19 pandemic: A case report.

RATIONALE: Vestibular schwannoma (VS) is a benign tumor commonly presenting with progressive hearing loss, tinnitus, and disequilibrium. However, in rare cases, it can mimic acute vestibular syndromes such as vestibular neuritis. Early recognition of such atypical presentations is essential for accurate diagnosis and timely management.

PATIENT CONCERNS: A 54-year-old woman experienced a sudden onset of sustained vertigo lasting 2 days without accompanying hearing loss or tinnitus. She had no prior history of vertigo.

DIAGNOSES: Neurotological assessments showed direction-fixed, horizontal-torsional nystagmus. Vestibular function tests revealed right-sided canal paresis on caloric testing and reduced vestibulo-ocular reflex gains across all right semicircular canals. Audiometry showed symmetrical, mild high-frequency hearing loss. Brain magnetic resonance imaging identified a 0.4 cm intracanalicular lesion consistent with VS.

INTERVENTIONS: The patient received oral corticosteroids, betahistine, ginkgo biloba extract, and vestibular rehabilitation therapy.

OUTCOMES: Vertigo symptoms improved within 2 weeks and resolved completely by 5 months. No recurrence of vertigo was observed during a 2-year follow-up. Hearing remained stable, and no surgical intervention was required due to the small tumor size.

LESSONS: VS can present with acute vestibular syndrome resembling vestibular neuritis, even in the absence of auditory symptoms. Comprehensive neurotological evaluation and high-resolution magnetic resonance imaging are crucial for differential diagnosis and management.