Central Vertigo Mimicking Acute Peripheral Vestibular Disorder
Seonhye Kim, MD Ji Soo Kim, MD, PhD
Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
ABSTRACT
Acute vestibular syndrome of severe vertigo, nausea/vomiting, spontaneous nystagmus and postural imbalance is commonly due to viral or post-viral inflammation of the vestibular nerve or labyrinth. However, similar symptoms and signs may occur in cerebellar or brainstem stroke in which vertigo may be an isolated or initial symptom without other focal neurologic deficits. Since cerebellar or brainstem strokes may be fatal, it is important to recognize acute vestibular syndrome of vascular etiologies. In general, central origin should be suspected in isolated vertigo when the patients show 1) central type nystagmus, 2) horizontal nystagmus with normal head impulse test, 3) skew deviation, 4) impaired smooth pursuit, 5) severe imbalance, 6) persistent dizziness in association with vascular risk factors, and 7) no improvement of vertigo and nystagmus in 48 hours.
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