The clue lies beyond the eyes: a case report of spontaneous vertebral artery dissection masquerading as vestibular neuritis

We report a patient with vertebral artery dissection who presented with selective vestibular involvement and preserved cochlear function. A 50-year-old woman presented with acute spontaneous vertigo for a day. Bedside and neurotologic evaluation showed results compatible with vestibular neuritis, except for the excruciating occipital headache and posterior neck pain. For this reason, computed tomography (CT) angiography and magnetic resonance imaging were performed. CT angiography revealed a segmental fusiform dilation with mild luminal irregularity at the V4 segment of the right vertebral artery. Magnetic resonance and digital subtraction angiography demonstrated a vertebral dissection in the corresponding area. Our patient implicates that the vestibular organ can be selectively impaired from vascular etiology, without involving the cochlea. Occipital headache and posterior neck pain can be a red flag for a vascular cause, even when neurotologic findings are otherwise compatible with inflammatory peripheral vestibulopathy.