An Interesting Unknown Combined Pathology in a Patient with Acute Balance Problem

A 54-year-old woman with acute-onset nausea and vomiting presented to outpatient clinic. She had headache for 3 weeks. She had difficulty during tandem gait and was falling to the right. Otherwise, her neurological examination was normal. She had normal hearing. VNG analysis revealed spontaneous nystagmus beating to the left with optical fixation. However, she had horizontal and slightly down-beating gaze-evoked nystagmus at primary gaze position. Temporal bone CT and MRI showed widespread encephalitis of the right side of the brain and isolated destruction of the right superior semicircular canal. The patient was treated with high-dose combined antibiotics. She had remarkable recovery within 3 weeks.