Inferior peduncle lesion presenting with bilaterally impaired vestibular responses to horizontal and posterior head impulses

Differentiating central from peripheral origins of vestibulo‐ocular reflex (VOR) lesions can be challenging. A 36‐year old man presented with a 1‐year history of progressive unsteadiness. The video‐Head Impulse Test revealed a significantly reduced VOR gain in both horizontal and posterior canals (0.49 ± 0.05 and 0.38 ± 0.06) but normal VOR responses in both anterior canals (0.89 ± 0.08 and 1.04 ± 0.15). No plausible combination of end‐organ lesion should be responsible for these observations. A brain magnetic resonance imaging disclosed a left inferior cerebellar peduncle lesion suggestive of a glioma. Laryngoscope , 125:2386–2387, 2015