Nystagmus phenotypes in posterior circulation stroke

Acute vestibular syndrome (AVS) is characterized by sudden, persistent vertigo or dizziness with nausea, vomiting, postural instability, and spontaneous nystagmus. Differentiating peripheral vestibular disorders from posterior circulation stroke remains a major diagnostic challenge in emergency neurology, as vestibulo-cerebellar infarcts may present as "central pseudo-neuritis," mimicking peripheral vestibular...

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Clinicians evaluating acute vestibular syndrome should be familiar with nystagmus patterns associated with posterior circulation stroke, as this study adds characterization data that may sharpen bedside differential diagnosis — but prospective validation with HINTS-exam integration is needed before changing protocols.

Misdiagnosing a posterior circulation stroke as a peripheral vestibular disorder remains a significant patient-safety risk, and better characterization of nystagmus phenotypes directly supports improved triage.

1. 01Study characterizes nystagmus subtypes seen in posterior circulation stroke presenting as acute vestibular syndrome.
2. 02Accurate differential diagnosis between stroke and inner-ear disorders at bedside is a major clinical challenge.
3. 03Published in Frontiers in Neurology (2026).
4. 04Findings could complement existing bedside tools like the HINTS examination.
5. 05Retrospective or cross-sectional design limits causal inference.

PMID

42712447

DOI

10.3389/fneur.2026.1916451.

Journal

Frontiers in Neurology

Publication type

research_article

Evidence level

4

Population

Patients presenting with acute vestibular syndrome due to posterior circulation stroke

Intervention

Characterization of nystagmus phenotypes

Comparator

Peripheral vestibular disorders / other acute vestibular syndrome etiologies