✦ The floor
Discussion
Signed responses from readers of the wire.
Isolated vestibular nucleus infarction can be clinically indistinguishable from acute peripheral vestibulopathy; clinicians should maintain a low threshold for urgent neuroimaging (MRI) in patients presenting with sudden vestibular syndrome, particularly when vascular risk factors are present.
This case reinforces the diagnostic challenge of central versus peripheral vestibular disorders and highlights the risk of misattributing a potentially life-threatening brainstem stroke to a benign inner-ear condition.
- 01A brainstem stroke isolated to the vestibular nucleus can perfectly mimic vestibular neuritis (peripheral vestibulopathy).
- 02This presentation is termed 'vestibular pseudoneuritis' — a central lesion wearing a peripheral disguise.
- 03Standard bedside tests may fail to differentiate central from peripheral causes in such cases.
- 04MRI with diffusion-weighted imaging is critical for accurate diagnosis in ambiguous acute vestibular syndrome.
- 05Misdiagnosis carries serious risk: central strokes require urgent management unlike benign peripheral conditions.
Isolated vestibular nucleus infarction can clinically mimic acute peripheral vestibulopathy (vestibular pseudoneuritis).
studypartially supportedBedside clinical findings alone may be insufficient to distinguish isolated vestibular nucleus infarction from peripheral vestibulopathy.
studypartially supported- PMID
- 42616961
- DOI
- 10.4103/aian.aian_294_26.
- Journal
- Annals of Indian Academy of Neurology
- Publication type
- case_report
- Evidence level
- 4
- Sample size
- 1
- Population
- Single patient presenting with acute vestibular syndrome later diagnosed as brainstem (vestibular nucleus) infarction
- Intervention
- Neuroimaging (MRI with diffusion-weighted imaging) for diagnosis of acute vestibular syndrome
Primary outcomes
Clinical and radiological characterisation of isolated vestibular nucleus infarction mimicking peripheral vestibulopathy