Isolated central vestibular syndrome

Area of Science:

• Neuroscience
• Otolaryngology

Background:

• Isolated vestibular syndrome can affect pathways from the peripheral labyrinth to the brain.
• Advances in neurotology and neuroimaging are improving the diagnosis of central vestibulopathy.

Purpose of the Study:

• To review five distinct syndromes of isolated central vestibular syndrome.
• To introduce a new syndrome involving the inferior cerebellar peduncle.
• To highlight diagnostic challenges and considerations for central vestibular lesions.

Main Methods:

• Review of existing literature on isolated central vestibular syndromes.
• Clinical case analysis focusing on lesion localization.
• Discussion of neuroimaging findings, including diffusion-weighted MRI.

Main Results:

• Five syndromes linked to specific central vestibular structures (vestibular nuclei, nucleus prepositus hypoglossi, flocculus, tonsil, nodulus) are described.
• A novel syndrome associated with isolated inferior cerebellar peduncle involvement is proposed.
• Decreased head impulse responses do not rule out central lesions; acute stroke may yield false-negative MRI.

Conclusions:

• Recognition of specific isolated central vestibular syndromes aids lesion localization.
• Thorough clinical assessment is vital, even with peripheral signs or negative MRI.
• Understanding these syndromes improves the diagnosis and management of central vestibulopathy.