LAUSR

BACKGROUND Exclusion of stroke is the focus of guidelines in Emergency Department assessment of acute vertigo, especially with new onset atrial fibrillation (AF). Early diagnosis of vestibular neuritis (VN) is also important but may be deferred awaiting brain MRI for exclusion of stroke. This may delay potentially beneficial corticosteroid therapy. AIMS We aim to highlight that VN can provoke acute AF. METHODS In the course of a prospective study of acute vertigo in patients assessable within 24 h of admission we encountered three patients with acute onset transient AF associated with VN. We performed a detailed neurological examination and quantitated the vestibulo-ocular reflex (VOR) gain with video-oculography (VOG). Brain MRI was performed in all patients. RESULTS There were two men and one woman, ages 58-66 (mean 61). All patients had typical non-direction-changing rotatory nystagmus and positive head impulse tests. The horizontal VOR gains ranged 0.38-0.62 (mean 0.47). Diffusion weighted imaging MRI within 36 h was normal in all. AF reverted in all three within 24 h. CONCLUSIONS Acute AF can be precipitated by vertigo such as in VN. In VN, the concurrence of acute AF may distract from the correct neurological diagnosis, delaying potentially beneficial corticosteroid therapy, especially if exclusion of stroke is dependent on MRI which may be delayed. This article is protected by copyright. All rights reserved.