Acute Vestibular Syndrome

Rapid, unilateral injury to either peripheral or central vestibular structures produces the acute vestibular syndrome, which consists of severe vertigo, nausea and vomiting, spontaneous nystagmus, and postural instability. When this syndrome evolves over days in a healthy person, it is usually attributed to a viral vestibular neuritis, also called vestibular neuronitis or, when acute hearing loss occurs, neurolabyrinthitis.16 Infarction and hemorrhage of the inferior cerebellum, however, may simulate vestibular neuritis (Figure 1).9,10 As many as 25 percent of patients with risk factors for stroke who present to an emergency medical setting with isolated, severe vertigo, nystagmus, and postural . . .