title: Misdiagnosis of acute peripheral vestibulopathy in central nervous ischemic infarction.
abstract: BACKGROUND
  Vertigo is a very common symptom at otorhinolaryngology (ENT), neurological, and emergency units, but often, it is difficult to distinguish between vertigo of peripheral and central origin.
  
  
  METHODS
  We conducted a retrospective analysis of a hospital database, including all patients admitted to the ENT University Hospital Graz after neurological examination, with a diagnosis of peripheral vestibular vertigo and subsequent diagnosis of central nervous infarction as the actual cause for the vertigo. Twelve patients were included in this study.
  
  
  RESULTS
  All patients with acute spinning vertigo after a thorough neurological examination and with uneventful computed tomographic scans were referred to our ENT department. Nine of them presented with horizontal nystagmus. Only 1 woman experienced additional hearing loss. The mean diagnostic delay to the definite diagnosis of a central infarction through magnetic resonance imaging was 4 days (SD, 2.3 d).
  
  
  CONCLUSIONS
  A careful otologic and neurological examination, including the head impulse test and caloric testing, is mandatory. Because ischemic events cannot be diagnosed in computed tomographic scans at an early stage, we strongly recommend to perform cranial magnetic resonance imaging within 48 hours from admission if vertigo has not improved under conservative treatment.
authors.affiliation: Division of Neuro-Otology, ENT University Hospital, Medical University of Graz, Graz, Austria. eva.braun@medunigraz.at
authors.forename: Eva Maria
authors.initials: EM
authors.lastname: Braun
authors.forename: Peter Valentin
authors.initials: PV
authors.lastname: Tomazic
authors.forename: Thorsten
authors.initials: T
authors.lastname: Ropposch
authors.forename: Ulrike
authors.initials: U
authors.lastname: Nemetz
authors.forename: Andreas
authors.initials: A
authors.lastname: Lackner
authors.forename: Christian
authors.initials: C
authors.lastname: Walch
mesh_terms: D000328:Adult; D000368:Aged; D020520:Brain Infarction / Q000150:complications / Q000175:diagnosis*; D002150:Caloric Tests; D016208:Databases, Factual; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009759:Nystagmus, Pathologic / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D014717:Vertigo / Q000150:complications / Q000175:diagnosis*; D020338:Vestibular Neuronitis / Q000150:complications / Q000175:diagnosis*