Abstract

Acute dizziness can be a diagnostic challenge for the clinician. The pattern of acute spontaneous vertigo without any sign of brainstem abnormality i.e acute isolated vertigo, includes both of benign peripheral and sinister central disorders. Although the majority of the acute isolated vertigo are the benign peripheral vestibulopathy such as vestibular neuritis, some of the central disorders especially, cerebellar stroke can appear to be quite similar to benign peripheral one. Among them, "pseudovestibular neuritis" by acute infarction in the medial branch of the posterior inferior cerebellar artery (mPICA), "psudolabyrintitis" by anterior inferior cerebellar artery (AICA) infarction, "pseudo-benign paroxysmal positional vertigo (p-BPPV)" by cerebellar vermal infarction, and vertebrobasilar insufficiency (VBI) occasionally harass physicians. Common benign peripheral disorders have unique clinical features allowing for bedside diagnosis. Therefore, if the presentation is not typical for a peripheral vestibular disorder, the possibility of the central disorder should be considered. Careful history and focused neurolotologic examinations including pattern of nystagmus, head thrust test, head shaking test, and severity of imbalance provide the key information for distinguishing benign peripheral causes from life-threatening central disorders.