Central vestibular lesion

Case contributed by Dr Mostafa El-Feky

Presentation

Vertigo, spontaneous nystagmus and imbalance.

Patient Data

Age: 65 years
Gender: Male
MRI

A tiny left pontine paramedian lesion is noted with high signal intensity on T2, low signal intensity on T1 and no diffusion restriction, suggestive of old ischemic (gliotic) lesion at the left vestibular nucleus.

Right occipital lobe and right cerebellar hemisphere old infarctions are noted.

No space-occupying lesions identified along the peripheral vestibular pathway.

Case Discussion

The patient presented with chronic vestibular syndrome. MRI study shows an old ischemic lesion along the central vestibular pathway, suggestive of chronic microvascular disease or embolic state. Its main blood supply comes from PICA, a branch of vertebral artery 1.

Lesions that affect the medial subnucleus is the most important causes of unilateral central canal paresis. Isolated vestibular nucleus infarction should be considered in the differential diagnosis of central vascular vertigo syndrome 2.

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Case information

rID: 68174
Published: 11th Jul 2019
Last edited: 11th Jul 2019
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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