A case report of labyrinthine infarction: a 'central' cause of vertigo with 'peripheral' presentation

The inner ear is considered an 'end organ' since its vascular supply comes from one terminal artery, making the labyrinth especially vulnerable to ischemia, causing loss of auditory and vestibular function with variable clinical patterns according to the different arterial distribution in the inner ear and which vascular branches are concerned by the embolism.

We report a misleading case of central vascular vertigo caused by a labyrinthine infarction resulting from an embolic vertebral artery, which manifested in a typical peripheral clinical presentation mimicking a vestibular neuritis.

Vertigo is the result of asymmetrical responses from the vestibules of both ears resulting from any disruption along the complex vestibular pathways, whether peripheral or central. The recognition of the origin of an acute isolated vertigo is fundamental since the therapeutic strategy and prognosis differ, but it can be challenging in the absence of neurological signs, especially when the clinical pattern involves only the vestibular part of the labyrinth.

The diagnosis strategy should consider the patient vascular risk factors and the clinical bedside tests with diffusion-weighted magnetic resonance imaging (MRI). Then, the management of these patients requires pluridisciplinary cooperation with early vestibular rehabilitation.