AUTHOR=Wang Huiyuan , Shi Tianming , Shang Yafei , Chen Xinyi , Xu Jie , Geng Yu 

TITLE=Case report: Spiller syndrome initially mimicking vestibular neuritis

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1072220

DOI=10.3389/fneur.2022.1072220

ISSN=1664-2295

ABSTRACT=Spiller syndrome is a rare subtype of medial medullary infarction (MMI). Herein, we report a patient with progressing stroke who presented with the initial features of acute peripheral vestibulopathy and MMI (Spiller syndrome), as confirmed by magnetic resonance imaging (MRI). A 42-year-old man experienced acute persistent vertigo with nausea, vomiting, and severe gait instability for 6 h before presenting to the emergency department. Spontaneous right-beating horizontal-torsional nystagmus was observed that intensified on rightward gaze. The patient fell to the left side during the Romberg test. Cranial computed tomography (CT) performed immediately upon admission did not find evidence of ischemia or hemorrhage of the brainstem and cerebellum but four hours after admission, the patient’s symptoms underwent exacerbation, manifesting as left-sided limb weakness and dysarthria, without dysphagia. Bedside examination also revealed difficulty in extending the tongue to the right, positive left Babinski's sign, and abnormal vibration and position sense in the paralyzed limb. Head impulse test recording revealed a normal gain in the vestibulo-ocular reflex, and numerous consistent covert corrective saccades were captured when the head was turned to the left side. Cranial MRI depicted an acute infarct confined to the right side of the medial medulla, which met the diagnostic criteria for Spiller syndrome. Our study underscores the importance of considering the possibility of a nucleus propositus hypoglossi lesion even if the signs and symptoms support the diagnosis of peripheral lesions in patients with acute vestibular syndrome with vascular risk factors.