Management of common central vestibular disorders

This article reviews the current literature on neurological disorders causing vestibular signs and symptoms. The review focusses on vestibular migraine, vestibular stroke syndromes, and supratentorial gait disorders.

A familiar type of vestibular migraine with autosomal dominant inheritance has been linked to chromosome 5q35. In patients with vestibular migraine, vestibular testing in the asymptomatic interval, including VEMPs, produces heterogeneous and often only minor abnormalities. Migraine headaches can be triggered by vestibular stimulation suggesting that the relation of migraine and vestibular symptoms is bidirectional.Peripheral audiovestibular loss is a common accompaniment of anterior inferior cerebellar artery occlusion. Various brainstem and cerebellar stroke syndromes may mimic acute peripheral vestibular loss but can be differentiated clinically.The periventricular region and the anterior corpus callosum have been identified as specific localizations of cerebral white matter disease that interfere with gait and balance.

Although vestibular migraine has been well delineated as a clinical syndrome, knowledge on its pathophysiology is scarce. To date, recommendations for treatment are based on clinical case series rather than randomized trials. Our understanding of ischemic vertigo has improved since stroke registers have provided large patient series with specific cerebellar and brainstem stroke syndromes. Cerebral white matter disease produces different clinical syndromes according to its severity and anatomical predilection.