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Bedside differentiation of vestibular neuritis from central “vestibular pseudoneuritis”
  1. C D Cnyrim1,
  2. D Newman-Toker2,
  3. C Karch1,
  4. T Brandt1,
  5. Michael Strupp1
  1. 1
    Department of Neurology, University of Munich, Munich, Germany
  2. 2
    Departments of Neurology and Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, USA
  1. Dr C D Cnyrim, Department of Neurology, University of Munich, Marchioninistr 15, D-81377 Munich, Germany; christian.cnyrim{at}


Acute unilateral peripheral and central vestibular lesions can cause similar signs and symptoms, but they require different diagnostics and management. We therefore correlated clinical signs to differentiate vestibular neuritis (40 patients) from central “vestibular pseudoneuritis” (43 patients) in the acute situation with the final diagnosis assessed by neuroimaging. Skew deviation was the only specific but non-sensitive (40%) sign for pseudoneuritis. None of the other isolated signs (head thrust test, saccadic pursuit, gaze evoked nystagmus, subjective visual vertical) were reliable; however, multivariate logistic regression increased their sensitivity and specificity to 92%.

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  • Competing interests: None.

  • Ethics approval: Ethics approval was obtained.