{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T10:13:23Z","timestamp":1777976003648,"version":"3.51.4"},"reference-count":5,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R25 DC021243"],"award-info":[{"award-number":["R25 DC021243"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>A 76\u2010year\u2010old man presented with a 2\u2010week history of intermittent episodic rotational vertigo accompanied by blurred vision, vomiting, and imbalance. Neurologic examination revealed no sensory, motor, or cranial nerve deficits. However, the head impulse, nystagmus, and test of skew (HINTS) exam demonstrated right\u2010beating nystagmus that intensified with visual suppression, a vertical skew deviation with right hyperphoria, and a normal vestibulo\u2010ocular reflex (VOR) on video head impulse testing (vHIT), except for clustered refixation saccades for rotations in the plane of the left horizontal semicircular canal. Following a thorough workup, a posterior fossa stroke was ruled out and the patient was diagnosed with vestibular migraine (VM) and Meniere's Disease (MD). This case highlights the diagnostic considerations for episodic vestibular syndrome (EVS) in a patient with significant cardiovascular risk factors. We discuss the differential diagnosis, emphasizing the need for thorough history, targeted examination, and imaging to refine diagnostic interpretation, particularly in the context of positive skew deviation.<\/jats:p>","DOI":"10.1002\/lary.70312","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T08:14:13Z","timestamp":1767341653000},"page":"2324-2327","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A 76\u2010Year\u2010Old Man With Episodic Vestibular Syndrome and Skew Deviation"],"prefix":"10.1002","volume":"136","author":[{"given":"Yassine","family":"Balhi","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6179-5252","authenticated-orcid":false,"given":"Syed Ameen","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan K.","family":"Ward","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John P.","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaapos.2009.11.019"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.551234"},{"key":"e_1_2_8_4_1","unstructured":"D. E.Newman\u2010Toker \u201cEpisodic Vestibular Syndrome.\u201d"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.032488"},{"key":"e_1_2_8_6_1","doi-asserted-by":"crossref","unstructured":"\u201cAcute Transient Vestibular Syndrome | Stroke [Internet] \u201d2025 https:\/\/doi.org\/10.1161\/STROKEAHA.116.015507.","DOI":"10.1161\/STROKEAHA.116.015507"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.70312","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.70312","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.70312","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:40:36Z","timestamp":1777974036000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.70312"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,2]]},"references-count":5,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/lary.70312"],"URL":"https:\/\/doi.org\/10.1002\/lary.70312","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,2]]},"assertion":[{"value":"2025-04-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}