Isolated vestibular nucleus infarction mimicking acute peripheral vestibulopathy

BACKGROUND AND PURPOSE: Although several articles have been published on central vestibular syndrome mimicking acute peripheral vestibulopathy (ie, pseudo-acute peripheral vestibulopathy), there are no reports of a brainstem infarct that selectively involves the vestibular nucleus and causes isolated vertigo.

SUMMARY OF CASE: We report a patient with an isolated vestibular nucleus infarction who presented with isolated prolonged vertigo, spontaneous horizontal nystagmus with a torsional component, a positive head impulse test result, and unilateral canal paresis to caloric stimulation.

CONCLUSIONS: This is the first report of pseudo-acute peripheral vestibulopathy associated with isolated vestibular nucleus infarction. Isolated vestibular nucleus infarction should be considered in the differential diagnosis of central vascular vertigo syndrome, especially when the patient has unilateral canal paresis but without other neurologic symptoms or signs.