# Cerebellar Hemorrhage Masquerading as Unilateral Vestibulopathy: A Case Report

## TL;DR

A rare case of cerebellar hemorrhage mimicking a common inner ear disorder highlights the need for careful differential diagnosis.

## Contribution

This case report highlights a rare cerebellar hemorrhage presenting as pseudovestibular syndrome, emphasizing diagnostic challenges.

## Key findings

- Cerebellar hemorrhage can mimic unilateral vestibular neuritis by disrupting flocculus-vestibular nucleus connections.
- Central pathologies may manifest with abnormal vestibulo-ocular reflexes, complicating diagnosis.
- The case underscores the importance of considering central causes in patients with apparent peripheral vestibulopathy.

## Abstract

Pseudovestibular syndrome refers to central pathologies that mimic acute unilateral peripheral vestibulopathy, often posing a diagnostic challenge, particularly when key symptoms indicating a central origin are absent. The most common etiology is brain ischemia resulting from posterior inferior cerebellar artery occlusion. This article presents a rare case of a left paramedian cerebellar hemorrhage initially misdiagnosed as right-sided vestibular neuritis. Cerebellar hemorrhage can induce pseudovestibular syndrome by disrupting the connective fibers from the flocculus to the ipsilateral vestibular nucleus in the pons. Additionally, central pathologies affecting the vestibular system may occasionally manifest a pathological vestibulo-ocular reflex. This case report underscores the importance of considering potentially severe central-origin conditions in the differential diagnosis of seemingly benign unilateral peripheral vestibulopathy.