Acute vestibular syndrome induced by supratentorial stroke: clinical features and network compensation mechanisms

Lesions showed left hemispheric predominance overall, but no clear hemispheric predominance for specific symptoms (50% of vertigo lesions were right-sided). Vertigo was associated with cortical lesions (4/4), while dizziness more often involved subcortical structures (6/9), suggesting different mechanisms: acute disruption of vestibular-visual integration versus impaired vestibulo-cortical signaling via basal ganglia-thalamo-cortical circuits. In summary, AVS induced by supratentorial stroke results from the interplay between multimodal network impairment and dynamic compensation. The study highlights the need to incorporate detailed vestibular testing beyond HINTS to avoid missing supratentorial stroke in AVS patients, despite limitations like small sample size.