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Dr Carney's letter reminds his readers of a rare but important event, injury to a vertebral artery. When this occurs, and major ischemic consequences to the brain stem follow, the clinical picture includes major neurologic deficit with multiple features, presumably never an isolated abnormality such as vertigo and nystagmus.One might make a theoretical argument for complete or partial labyrinthine artery occlusion, but the almost inevitable consequence of this would be not only a considerable unilateral vestibular disturbance but also a substantial degree of hearing loss on the same side. In my view, major labyrinthine artery occlusion cannot be identified in the absence of either hearing or vestibular abnormality (caloric reduction).The patient referred to in Dr Carney's letter had normal hearing and was found to be neurologically intact by a consultant neurologist within 24 hours of onset of his severe vertigo.Sudden vestibular loss, partial or complete
Barber HO. Vertigo Following Whiplash— Vertebral Artery Injury?-Reply. JAMA. 1978;240(21):2246-2247. doi:10.1001/jama.1978.03290210028009