A patient with severe vertigo and nystagmus is most likely suffering from which condition?

Vestibular neuritis is characterized by sudden onset vertigo and often accompanies nystagmus. It is an inflammation of the vestibular nerve, which typically occurs following a viral infection. The hallmark symptoms are severe spinning sensations, balance difficulties, and sometimes accompanying nausea, which aligns well with the patient's presentation of severe vertigo and nystagmus.

Patients may experience persistent vertigo, particularly when moving their heads, but there’s usually no significant hearing loss associated with vestibular neuritis, which helps to differentiate it from conditions like acoustic neuroma, where auditory symptoms may be present due to tumor pressure on the auditory pathways.

Other options, while related to vestibular disturbances, do not fit the profile as closely. Acoustic neuroma generally involves gradual hearing loss and is characterized by a more chronic course of symptoms. Vestibular insufficiency may cause balance issues but does not typically lead to such intense vertiginous sensations or nystagmus as seen with vestibular neuritis. A transient ischemic attack (TIA) can present with vertigo, but it usually is accompanied by other neurological deficits, making it less likely in the absence of such symptoms.