{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:24:39Z","timestamp":1787747079761,"version":"build-2784847793"},"reference-count":84,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Multiple sclerosis (MS) is an autoimmune disorder that frequently presents with acute neurological symptoms during relapsing\u2013remitting phases. While motor, sensory, and visual deficits are widely recognized manifestations of relapses, vestibular symptoms such as acute vertigo, dizziness, and imbalance are comparatively under-recognized and often pose diagnostic challenges. This review synthesizes foundational and recent evidence regarding MS-related acute vestibular syndrome and its central pathophysiologic mechanisms. Infratentorial demyelinating plaques, most frequently localized within the pons and the middle cerebellar peduncles, disrupt large fiber systems and give rise to distinct central oculomotor signs. We highlight highly characteristic ocular motor features\u2014including internuclear ophthalmoplegia, wall-eyed bilateral INO, and acquired pendular nystagmus\u2014that serve as crucial topodiagnostic clues. Furthermore, we address clinical mimics, distinguishing central positional nystagmus and vertigo from benign paroxysmal positional vertigo, the latter being highly prevalent and treatable via bedside maneuvers in MS populations. Crucially, this paper examines the limitations of bedside tools like the HINTS exam, which identify central pathology but fail to differentiate ischemic stroke from acute demyelination. In the emergency setting, integrating advanced neuroimaging\u2014such as perfusion MRI, the central vein sign, and paramagnetic rim lesions\u2014with detailed ocular motor evaluation is vital. Lastly, we explore atypical fascicular lesions mimicking peripheral vestibulopathy and hypothesize how delayed, desynchronized axonal conduction in MS may impair the precise timing of covert saccades required for vestibular recovery, warranting future cohort investigations.<\/jats:p>","DOI":"10.3389\/fneur.2026.1888822","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:16:01Z","timestamp":1787746561000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multiple sclerosis as an under-recognized cause of acute vertigo: clinical and pathophysiologic insights"],"prefix":"10.3389","volume":"17","author":[{"given":"Evangelos","family":"Anagnostou","sequence":"first","affiliation":[{"name":"Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens","place":["Athens, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Kouvli","sequence":"additional","affiliation":[{"name":"Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens","place":["Athens, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e1316","DOI":"10.1002\/cti2.1316","article-title":"Pathogenesis of autoimmune demyelination: from multiple sclerosis to neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein antibody-associated disease","volume":"10","author":"Lopez","year":"2021","journal-title":"Clin Transl Immunol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1212\/CON.0000000000000737","article-title":"Phases and phenotypes of multiple sclerosis","volume":"25","author":"Kantarci","year":"2019","journal-title":"Continuum (Minneap Minn)"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e57","DOI":"10.1212\/01.wnl.0000310640.37810.b3","article-title":"Pearls & Oy-sters: the medical longitudinal fasciculus in ocular motor physiology","volume":"70","author":"Frohman","year":"2008","journal-title":"Neurology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1136\/practneurol-2016-001428","article-title":"Internuclear ophthalmoplegia","volume":"17","author":"Virgo","year":"2017","journal-title":"Pract Neurol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1001\/archneur.1985.04060080029011","article-title":"The clinical spectrum of internuclear ophthalmoplegia in multiple sclerosis","volume":"42","author":"M\u00fcri","year":"1985","journal-title":"Arch Neurol"},{"key":"ref6","first-page":"455","article-title":"Internuclear ophthalmoplegia: pathophysiology and diagnosis","volume":"1","author":"Zee","year":"1992","journal-title":"Baillieres Clin Neurol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1001\/archneur.62.5.714","article-title":"Internuclear ophthalmoplegia: unusual causes in 114 of 410 patients","volume":"62","author":"Keane","year":"2005","journal-title":"Arch Neurol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.jns.2017.01.033","article-title":"Acquired pendular nystagmus","volume":"375","author":"Kang","year":"2017","journal-title":"J Neurol Sci"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"103523","DOI":"10.1016\/j.msard.2022.103523","article-title":"The Heimann-Bielschowsky phenomenon after optic neuritis","volume":"58","author":"Anagnostou","year":"2022","journal-title":"Mult Scler Relat Disord"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1097\/wno.0000000000001944","article-title":"Unilateral pendular nystagmus in multiple sclerosis: a case series","volume":"44","author":"Vosoughi","year":"2024","journal-title":"J Neuroophthalmol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1558","DOI":"10.1161\/STROKEAHA.110.582783","article-title":"Isolated vestibular nucleus infarction mimicking acute peripheral vestibulopathy","volume":"41","author":"Kim","year":"2010","journal-title":"Stroke"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1007\/s00415-013-7139-0","article-title":"Isolated vestibular nuclear infarction: report of two cases and review of the literature","volume":"261","author":"Kim","year":"2014","journal-title":"J Neurol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1136\/jnnp.55.6.446","article-title":"The site of brainstem lesions causing semicircular canal paresis: an MRI study","volume":"55","author":"Francis","year":"1992","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref14","first-page":"590","article-title":"Multiple sclerosis: a consideration in acute cranial nerve palsies","volume":"18","author":"Commins","year":"1997","journal-title":"Am J Otol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1566","DOI":"10.1212\/wnl.55.10.1566","article-title":"Vertigo in MS: utility of positional and particle repositioning maneuvers","volume":"55","author":"Frohman","year":"2000","journal-title":"Neurology"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1055\/s-0029-1241040","article-title":"Vestibular neuritis","volume":"29","author":"Strupp","year":"2009","journal-title":"Semin Neurol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1136\/practneurol-2021-003157","article-title":"Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO): what does it mean to be wall-eyed?","volume":"22","author":"Bennetto","year":"2022","journal-title":"Pract Neurol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1111\/cxo.12200","article-title":"Wall-eyed bilateral internuclear ophthalmoplegia: review of pathogenesis, diagnosis, prognosis and management","volume":"98","author":"Wu","year":"2015","journal-title":"Clin Exp Optom"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e36835","DOI":"10.7759\/cureus.36835","article-title":"Wall-eyed bilateral internuclear ophthalmoplegia as an early presentation of multiple sclerosis","volume":"15","author":"Zainal Abidin","year":"2023","journal-title":"Cureus."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.pediatrneurol.2024.05.002","article-title":"Wall-eyed bilateral internuclear ophthalmoplegia as part of the clinical presentation of pediatric multiple sclerosis, successfully treated with therapeutic plasma exchange","volume":"158","author":"Shakin","year":"2024","journal-title":"Pediatr Neurol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1097\/NRL.0000000000000271","article-title":"Wall-eyed bilateral internuclear ophthalmoplegia by ischemic stroke: case report and literature review","volume":"25","author":"Uzawa","year":"2020","journal-title":"Neurologist"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1001\/archneur.65.6.827","article-title":"Progressive supranuclear palsy with wall-eyed bilateral internuclear ophthalmoplegia syndrome","volume":"65","author":"Matsumoto","year":"2008","journal-title":"Arch Neurol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1097\/WNO.0b013e318175ccfe","article-title":"Wall-eyed bilateral internuclear ophthalmoplegia in a patient with progressive supranuclear palsy","volume":"28","author":"Ushio","year":"2008","journal-title":"J Neuroophthalmol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1208902","DOI":"10.3389\/fneur.2023.1208902","article-title":"Systematic review and meta-analysis of the diagnostic accuracy of spontaneous nystagmus patterns in acute vestibular syndrome","volume":"14","author":"W\u00fcthrich","year":"2023","journal-title":"Front Neurol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1097\/WCO.0000000000001444","article-title":"Acute vertigo: stroke or not?","volume":"39","author":"Kaski","year":"2026","journal-title":"Curr Opin Neurol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.1002\/lary.5541011207","article-title":"Clinical application of saccade-reflex testing in man","volume":"101","author":"Konrad","year":"1991","journal-title":"Laryngoscope"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1001\/archneur.1992.00530280116034","article-title":"Multiple sclerosis as a cause of atrial fibrillation and electrocardiographic changes","volume":"49","author":"Schroth","year":"1992","journal-title":"Arch Neurol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1007\/BF00176947","article-title":"Preclinical detection of initial vestibulocochlear abnormalities in a patient with multiple sclerosis","volume":"250","author":"Gstoettner","year":"1993","journal-title":"Eur Arch Otorrinolaringol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1159\/000276609","article-title":"Multiple sclerosis presented acute hearing loss and vertigo","volume":"56","author":"Sasaki","year":"1994","journal-title":"ORL J Otorhinolaryngol Relat Spec"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1136\/jnnp.65.6.945","article-title":"High resolution magnetic resonance imaging in peripheral vestibular dysfunction in multiple sclerosis","volume":"65","author":"Gass","year":"1998","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"52","DOI":"10.3109\/00206099809072961","article-title":"Multiple sclerosis: a cause of sudden hearing loss","volume":"37","author":"Oz\u00fcnl\u00fc","year":"1998","journal-title":"Audiology"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1136\/jnnp.66.3.340","article-title":"Pontine lesions mimicking acute peripheral vestibulopathy","volume":"66","author":"Th\u00f6mke","year":"1999","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"393","DOI":"10.15537\/1658-3175.1157","article-title":"Tumor-like presentation of multiple sclerosis","volume":"21","author":"Al-Bunyan","year":"2000","journal-title":"Saudi Med J"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1212\/WNL.57.5.887","article-title":"Perverted head-shaking nystagmus: a possible mechanism","volume":"57","author":"Minagar","year":"2001","journal-title":"Neurology"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1034\/j.1600-0404.2002.01348.x","article-title":"Familial multiple sclerosis: case study of three affected siblings","volume":"106","author":"Bencsik","year":"2002","journal-title":"Acta Neurol Scand"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1212\/01.wnl.0000036304.22698.24","article-title":"Parinaud syndrome heralding multiple sclerosis","volume":"60","author":"Lee","year":"2003","journal-title":"Neurology"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1191\/1352458504ms1041oa","article-title":"Vestibular evoked myogenic potentials in multiple sclerosis: clinical and imaging correlations","volume":"10","author":"Alpini","year":"2004","journal-title":"Mult Scler"},{"key":"ref38","first-page":"169","article-title":"Ankylosing spondylitis and multiple sclerosis in an HLA-B27 negative patient","volume":"104","author":"Tan","year":"2004","journal-title":"Acta Neurol Belg"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1177\/000348940411300909","article-title":"Audiovestibular evolution in a patient with multiple sclerosis","volume":"113","author":"Tu","year":"2004","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1136\/jnnp.2005.084624","article-title":"Positional nystagmus and vertigo due to a solitary brachium conjunctivum plaque","volume":"77","author":"Anagnostou","year":"2006","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"149","DOI":"10.17712\/1658-3183.1492","article-title":"An unusual case of isolated trochlear nerve palsy","volume":"12","author":"Jan","year":"2007","journal-title":"Neurosciences (Riyadh)"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.jns.2007.09.013","article-title":"A minute demyelinating lesion causing acute positional vertigo","volume":"266","author":"Anagnostou","year":"2008","journal-title":"J Neurol Sci"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1177\/000348940811700305","article-title":"Sequential bilateral hearing loss in multiple sclerosis","volume":"117","author":"Oh","year":"2008","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1177\/0883073807313040","article-title":"Increased intracranial pressure in a case of pediatric multiple sclerosis","volume":"23","author":"Williams","year":"2008","journal-title":"J Child Neurol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1177\/0883073808324769","article-title":"Acute tumefactive demyelinating lesions in a pediatric patient with known diagnosis of multiple sclerosis: review of the literature and treatment proposal","volume":"24","author":"Dastgir","year":"2009","journal-title":"J Child Neurol"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1179\/016164110X12681290831405","article-title":"Clinical and electronystagmographical evaluation of vestibular symptoms in relapsing remitting multiple sclerosis","volume":"32","author":"Degirmenci","year":"2010","journal-title":"Neurol Res"},{"key":"ref47","first-page":"17","article-title":"Hyperventilation-induced nystagmus in a large series of vestibular patients","volume":"31","author":"Califano","year":"2011","journal-title":"Acta Otorhinolaryngol Ital"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.jns.2013.02.017","article-title":"Downbeat nystagmus associated with damage to the medial longitudinal fasciculus of the pons: a vestibular balance control mechanism via the lower brainstem paramedian tract neurons","volume":"328","author":"Nakamagoe","year":"2013","journal-title":"J Neurol Sci"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1649","DOI":"10.1007\/s00415-013-6850-1","article-title":"Multiple sclerosis as a cause of the acute vestibular syndrome","volume":"260","author":"Pula","year":"2013","journal-title":"J Neurol"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/j.amjoto.2014.03.012","article-title":"Recent onset disequilibrium mimicking acute vestibulopathy in early multiple sclerosis","volume":"35","author":"Barona-Lleo","year":"2014","journal-title":"Am J Otolaryngol"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"37","DOI":"10.3988\/jcn.2014.10.1.37","article-title":"Primary position upbeat nystagmus during an acute attack of multiple sclerosis","volume":"10","author":"Kim","year":"2014","journal-title":"J Clin Neurol"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1111\/ene.12705","article-title":"Inferior cerebellar peduncular lesion causes a distinct vestibular syndrome","volume":"22","author":"Choi","year":"2015","journal-title":"Eur J Neurol"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"585","DOI":"10.3389\/fneur.2017.00585","article-title":"Paroxysmal symptoms as the first manifestation of multiple sclerosis mimicking a transient ischemic attack: a report of two cases","volume":"8","author":"Zhang","year":"2017","journal-title":"Front Neurol"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"160","DOI":"10.5152\/iao.2018.5225","article-title":"Auditory evoked potential inconsistency in sudden unilateral hearing loss with multiple sclerosis","volume":"15","author":"Lee","year":"2019","journal-title":"J Int Adv Otol"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"782","DOI":"10.3389\/fneur.2020.00782","article-title":"Case report: a case of severe clinical deterioration in a patient with multiple sclerosis","volume":"11","author":"Breitkopf","year":"2020","journal-title":"Front Neurol"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"e9959","DOI":"10.7759\/cureus.9959","article-title":"The medial longitudinal fasciculus and internuclear opthalmoparesis: there's more than meets the eye","volume":"12","author":"Fiester","year":"2020","journal-title":"Cureus."},{"key":"ref57","doi-asserted-by":"publisher","first-page":"110048","DOI":"10.1016\/j.ijporl.2020.110048","article-title":"Acute vestibular syndrome and hearing loss mimicking labyrinthitis as initial presentation of multiple sclerosis","volume":"134","author":"Valente","year":"2020","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"e19591","DOI":"10.7759\/cureus.19591","article-title":"Multiple sclerosis masquerading as post Septorhinoplasty complication: a case report","volume":"13","author":"Alolayet","year":"2021","journal-title":"Cureus."},{"key":"ref59","doi-asserted-by":"publisher","first-page":"123","DOI":"10.5811\/cpcem.2020.10.48448","article-title":"New onset nystagmus in a patient with multiple sclerosis","volume":"5","author":"Daugherty","year":"2021","journal-title":"Clin Pract Cases Emerg Med"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"636S","DOI":"10.1177\/0145561319897983","article-title":"Multiple sclerosis presenting as an anterior semicircular canal benign paroxysmal positional vertigo: case report","volume":"100","author":"Musat","year":"2021","journal-title":"Ear Nose Throat J"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"e32799","DOI":"10.7759\/cureus.32799","article-title":"A case of multiple sclerosis uncovered following Moderna SARS-CoV-2 vaccination","volume":"14","author":"Ahoussougbemey Mele","year":"2022","journal-title":"Cureus."},{"key":"ref62","doi-asserted-by":"publisher","first-page":"2041","DOI":"10.3390\/biomedicines10082041","article-title":"Juvenile idiopathic arthritis, uveitis and multiple sclerosis: description of two patients and literature review","volume":"10","author":"Chighizola","year":"2022","journal-title":"Biomedicine"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"e6154","DOI":"10.1002\/ccr3.6154","article-title":"Central positional vertigo as first initial multiple sclerosis symptom: a case report with systematic review","volume":"10","author":"Meshref","year":"2022","journal-title":"Clin Case Reports"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1080\/00207454.2020.1829617","article-title":"Multiple sclerosis attack case presenting with pseudo-vestibular neuritis","volume":"132","author":"Surmeli","year":"2022","journal-title":"Int J Neurosci"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"e20210153","DOI":"10.1590\/2317-1782\/20232021153pt","article-title":"Neurological and vestibular findings in three cases of multiple sclerosis. Achados neurol\u00f3gicos e vestibulares em tr\u00eas casos de Esclerose M\u00faltipla","volume":"35","author":"Evangelista","year":"2023","journal-title":"Codas"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"e54972","DOI":"10.7759\/cureus.54972","article-title":"Postpartum onset of multiple sclerosis: a case report","volume":"16","author":"Afonso","year":"2024","journal-title":"Cureus"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"1789381","DOI":"10.1155\/crii\/1789381","article-title":"Gastroparesis-an often-overlooked sign of multiple sclerosis: case report","volume":"2025","author":"Kukan","year":"2025","journal-title":"Case Reports Immunol"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"11S","DOI":"10.1177\/01455613221148310","article-title":"Association between multiple sclerosis and the symptoms of vertigo and facial nerve palsy","volume":"104","author":"Yoshida","year":"2025","journal-title":"Ear Nose Throat J"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1136\/jnnp.2006.100420","article-title":"Epidemiology of benign paroxysmal positional vertigo: a population based study","volume":"78","author":"von Brevern","year":"2007","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1191\/1352458503ms901oa","article-title":"Benign paroxysmal positioning vertigo in multiple sclerosis: diagnosis, pathophysiology and therapeutic techniques","volume":"9","author":"Frohman","year":"2003","journal-title":"Mult Scler"},{"key":"ref71","doi-asserted-by":"publisher","first-page":"e046510","DOI":"10.1136\/bmjopen-2020-046510","article-title":"Epley manoeuvre for posterior semicircular canal benign paroxysmal positional vertigo in people with multiple sclerosis: protocol of a randomised controlled trial","volume":"11","author":"Garc\u00eda-Mu\u00f1oz","year":"2021","journal-title":"BMJ Open"},{"key":"ref72","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1136\/pn-2023-003884","article-title":"Posterior semicircular canal cupulolithiasis during acute pontomedullary demyelination","volume":"24","author":"Matos","year":"2024","journal-title":"Pract Neurol"},{"key":"ref73","first-page":"1","article-title":"Diagnostic criteria for central versus peripheral positioning nystagmus and vertigo: a review","volume":"119","author":"B\u00fcttner","year":"1999","journal-title":"Acta Otolaryngol"},{"key":"ref74","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/bs.pbr.2019.04.012","article-title":"Central positional nystagmus: characteristics and model-based explanations","volume":"249","author":"Choi","year":"2019","journal-title":"Prog Brain Res"},{"key":"ref75","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1159\/000275390","article-title":"Positional nystagmus of the persistent type","volume":"40","author":"Thomsen","year":"1978","journal-title":"ORL J Otorhinolaryngol Relat Spec"},{"key":"ref76","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/bs.pbr.2019.04.022","article-title":"Central positional vertigo: a clinical-imaging study","volume":"249","author":"De Schutter","year":"2019","journal-title":"Prog Brain Res"},{"key":"ref77","doi-asserted-by":"publisher","first-page":"1851","DOI":"10.1007\/s00415-021-10852-8","article-title":"Central positional nystagmus: an update","volume":"269","author":"Lemos","year":"2022","journal-title":"J Neurol"},{"key":"ref78","doi-asserted-by":"publisher","first-page":"e119","DOI":"10.1097\/mao.0000000000002067","article-title":"Positional testing in acute vestibular syndrome: a transversal and longitudinal study","volume":"40","author":"Lemos","year":"2018","journal-title":"Otol Neurotol"},{"key":"ref79","doi-asserted-by":"publisher","first-page":"1539617","DOI":"10.3389\/fnins.2025.1539617","article-title":"7T MRI in the evaluation of ischemic stroke: a systematic review","volume":"19","author":"Kurz","year":"2025","journal-title":"Front Neurosci"},{"key":"ref80","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/s10072-025-08685-8","article-title":"Current state and advancements of imaging in acute ischemic stroke: a practical review","volume":"47","author":"Al-Salahat","year":"2025","journal-title":"Neurol Sci"},{"key":"ref81","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1055\/a-2694-4877","article-title":"Updates in multiple sclerosis imaging","volume":"45","author":"Schmidt","year":"2025","journal-title":"Semin Neurol"},{"key":"ref82","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1016\/j.neurol.2025.12.011","article-title":"Contribution of new imaging sequences to the diagnosis of multiple sclerosis","volume":"182","author":"Moccia","year":"2026","journal-title":"Rev Neurol (Paris)"},{"key":"ref83","doi-asserted-by":"publisher","first-page":"886","DOI":"10.3109\/00016489.2015.1035401","article-title":"Hitcal: a software tool for analysis of video head impulse test responses","volume":"135","author":"Rey-Martinez","year":"2015","journal-title":"Acta Otolaryngol"},{"key":"ref84","doi-asserted-by":"publisher","first-page":"1832160","DOI":"10.3389\/fneur.2026.1832160","article-title":"Vestibular recovery and central compensation after acute unilateral vestibulopathy\u2014changes in saccadic response patterns and gains over time","volume":"17","author":"Sj\u00f6gren","year":"2026","journal-title":"Front Neurol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1888822\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:16:03Z","timestamp":1787746563000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1888822\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":84,"alternative-id":["10.3389\/fneur.2026.1888822"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1888822","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"article-number":"1888822"}}