Vascular vertigo syndromes

Abstract

Ischemia,hemorrhages, and other vascular disorders can result in various central or peripheral vestibular syndromes with vertigo, oculomotor/balance disturbances, and nausea. The vascular vertigo syndromes listed in Table 1 can however be brought about by other causes such as demyelitizing focuses in multiple sclerosis or space-occupying lesions, so that not only localization of the damaged structure but also the various etiologies are decisive for the choice of therapy. Occasionally, combined functional disturbances of the peripheral and central vestibular system appear, such as an infarction of the inferior anterior cerebellar artery, which supplies the labyrinth and parts of the brainstem and cerebellum. In rare cases, a central lesion can have the same signs as a peripheral-vertibular disturbance: a lacunar infarct at the root entry zone of the eighth nerve can mimic a unilateral partial loss of labyrinth function as it occurs in vestibular neuritis, thus named "pseudoneuritis". Differential diagnosis between vestibular migraine, vestibular paroxysmia, transient ischemic brainstem attacks, and Meniere's disease is sometimes so difficult that only trial therapies such as prophylaxis with beta blockers, carbamazepine, thrombocyte aggregation inhibitors, antiplatelet drugs, or betahistin can clarify the issue.