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December 2014; 4 (6) Cases

Acute peripheral vestibulopathy in a cocaine addict

Cracking the vestibular nucleus

Anteneh M. Feyissa, Todd Masel, Stephen P. Busby
First published August 20, 2014, DOI: https://doi.org/10.1212/CPJ.0000000000000057
Anteneh M. Feyissa
Department of Neurology, University of Texas Medical Branch at Galveston, Galveston, TX.
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Todd Masel
Department of Neurology, University of Texas Medical Branch at Galveston, Galveston, TX.
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Stephen P. Busby
Department of Neurology, University of Texas Medical Branch at Galveston, Galveston, TX.
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Acute peripheral vestibulopathy in a cocaine addict
Cracking the vestibular nucleus
Anteneh M. Feyissa, Todd Masel, Stephen P. Busby
Neurol Clin Pract Dec 2014, 4 (6) 532-533; DOI: 10.1212/CPJ.0000000000000057

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A previously healthy 58-year-old man developed vertigo, imbalance, nausea, and vomiting shortly after smoking cocaine. He denied hearing loss, double vision, limb weakness, or sensory loss. Examination showed left-beating horizontal nystagmus with a torsional component, skew deviation, and positive right-sided head-impulse test. His urine tested positive for cocaine. Autoimmune workup, lipid panel, and echocardiography were unremarkable. MRI revealed acute right medial vestibular nucleus (VN) infarction (figure, A and B) and subcortical T2 hyperintensities (figure, C). Cerebral angiography was unremarkable. Presenting symptoms responded to meclizine and ondansetron, resolving by the third day.

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  • © 2014 American Academy of Neurology
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