Abstract Body

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 strokes in which vertigo may be an isolated or the 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. Even with marked developments in neuroimaging, however, well-organized bedside neurotologic evaluation is more sensitive than MRIs including diffusion-weighted ones in detecting acute infarction as a cause of spontaneous vertigo, especially during the first 48 hours. 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 tests, 3) skew deviation, 4) other central ocular motor signs (impaired vertical smooth pursuit, abnormal saccades, etc.) 5) severe imbalance, and 7) no improvement of vertigo and nystagmus in 48 hours.