Acute peripheral vestibular syndrome of a vascular cause

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.

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

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.

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.