Status vestibular migrainosus as a cause for acute vestibular syndrome

Abstract

Acute vestibular syndrome (AVS) is characterized by sudden-onset, continuous vertigo lasting more than 24 hours, accompanied by nausea, vomiting, and worsening with head movement. Common etiologies include vestibular neuritis, labyrinthitis, and posterior circulation stroke. Because of overlapping neurovascular supply, peripheral and central vestibular disorders can share clinical signs such as hearing loss, nystagmus, abnormal vestibulo-ocular reflex (VOR), and unstable gait. Status vestibular migrainosus, an extended episode of vestibular migraine (VM) with persistent vertigo and disequilibrium for over 24 hours-may mimic AVS and is often difficult to distinguish from vestibular disorders. We report a patient with status vestibular migrainosus whose features mimicked AVS. The clinical picture fulfilled the diagnostic criteria for AVS, with features typically attributed to peripheral vestibular pathology. Comprehensive evaluation, however, supported a diagnosis of status vestibular migrainosus, highlighting the diagnostic challenge posed by overlapping peripheral and central vestibular signs. Status vestibular migrainosus can present as AVS and closely resemble peripheral vestibular disorders. Awareness of this entity and careful clinical assessment are critical to avoid misdiagnosis and prompt recognition is essential for accurate management and prognosis.