Acute peripheral vestibular syndrome of a vascular cause.
BACKGROUND
Acute peripheral vestibular syndrome (APVS) is an idiopathic peripheral vestibulopathy characterized by prolonged vertigo (over 24 h), nausea, vomiting, and postural instability. There has been no previous report of APVS presumably of a vascular cause.


OBJECTIVE
To describe APVS presumably resulting from a vascular disturbance with embolic cerebral infarction.


METHODS
A 67-year-old woman developed sudden onset of severe isolated vertigo, nausea, and vomiting, which lasted for 3 days. Ten days earlier, she had had 4 episodes of transient vertigo lasting a few minutes. She had a spontaneous right-beating horizontal nystagmus with a torsional component, in the primary position and on gaze to the right or left. Caloric test showed a decreased response on the left side. Diffusion-weighted brain MRI showed 2 tiny acute infarcts in the left hippocampus and basal ganglia. Magnetic resonance angiogram showed no abnormalities. Continuous electrocardiographic monitoring for 24 h showed paroxysmal atrial fibrillation.


CONCLUSIONS
In this patient, clinical and laboratory findings were consistent with APVS. Considering the simultaneous onset of acute silent infarcts on brain MRI, the definite cardioembolic source with atrial fibrillation, and the episodic transient vertigo attacks before APVS, we speculate that small emboli arising from the heart may have lodged selectively in the anterior vestibular artery, producing APVS.
Kim
Hyun-Ah
HA
Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea.
Lee
Seong-Ryong
SR
Lee
Hyung
H
D000208:Acute Disease; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology; D001479:Basal Ganglia / Q000098:blood supply / Q000473:pathology; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D020520:Brain Infarction / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006321:Heart / Q000503:physiopathology; D006624:Hippocampus / Q000098:blood supply / Q000473:pathology; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D009325:Nausea / Q000209:etiology / Q000503:physiopathology; D009759:Nystagmus, Pathologic / Q000209:etiology / Q000503:physiopathology; D020127:Recovery of Function; D014715:Vertebrobasilar Insufficiency / Q000150:complications* / Q000503:physiopathology; D014717:Vertigo / Q000209:etiology / Q000503:physiopathology; D014722:Vestibule, Labyrinth / Q000098:blood supply / Q000503:physiopathology; D000160:Vestibulocochlear Nerve Diseases / Q000209:etiology* / Q000503:physiopathology