Brainstem vertigo: A brainstorming clinical entity for a clinician

Stroke at the brain stem and cerebellum may cause sudden vestibular syndromem and isolated audiovestibular loss can herald impeding for infarction at the anterior inferior cerebellar artery territory. Patients complaining sudden isolated dizziness or vertigo are higher chance for the stroke than the general population. Proper bedside assessment of the patient is superior to the imaging such as magnetic resonance imaging for detecting the central cause. Misdiagnosis of the stroke in patient of brain stem vertigo leads to significant morbidity and mortality. The overdiagnosis of this clinical entity will cause unnecessary costly workups and medical treatment. It is important for a clinician to differentiate brain stem vertigo with isolated dizziness or vertigo from the benign disorders of the labyrinth as the treatment strategy and prognosis are different in these two situations. Bedside clinical indicators are often helpful to identify the central pathology, and so neuroimaging should be advised accordingly. This review article focuses on the epidemiology, pathophysiology, clinical presentations, and current management of the brain stem vertigo. This article will surely increase awareness among the clinicians for accurate diagnosis and treatment of the brain stem vertigo.