Misleading signs in acute vertigo.

Area of Science:

• Neurology
• Otolaryngology

Background:

• Acute vestibular syndrome is a common neurological condition often presenting with vertigo.
• Clinical diagnosis can be challenging, even for experienced neurologists, due to overlapping symptoms and insensitive neuroimaging.
• Differentiating benign causes from serious underlying pathologies is critical for timely and appropriate management.

Observation:

• Two cases of acute vestibular syndrome with conflicting clinical findings are presented.
• Case 1: Vertigo with signs mimicking benign paroxysmal positional vertigo and vestibular neuritis, later diagnosed as vestibular schwannoma.
• Case 2: Abnormal head impulse test and skew deviation initially suggesting stroke, but attributed to a long-standing fourth nerve palsy.

Findings:

• Conflicting clinical signs in acute vestibular syndrome can lead to diagnostic delays.
• Vestibular schwannoma and cranial nerve palsies can present atypically, mimicking more common vestibular disorders.
• Thorough clinical evaluation and reassessment are crucial when initial diagnoses do not fully explain the presentation.

Implications:

• Highlights potential diagnostic pitfalls in evaluating acute vestibular syndrome.
• Emphasizes the importance of considering less common diagnoses when clinical features are discordant.
• Suggests strategies to improve diagnostic accuracy and avoid errors in managing vestibular disorders.