The vestibular system, essential for balance and spatial orientation, spans from the inner ear to various brain regions. Advances in imaging techniques have significantly enhanced our ability to diagnose and treat vestibular disorders. This review explores the anatomy of the vestibular system and evaluates the roles of high-resolution computed tomography (CT) and magnetic resonance imaging (MRI) in diagnosing structural abnormalities. CT is particularly useful for identifying bony labyrinth anomalies, temporal bone fractures, and superior canal dehiscence, though it has limitations in visualizing membranous labyrinth lesions. MRI, with its superior soft tissue resolution, is preferred for detecting retrocochlear lesions such as vestibular schwannomas, cerebellopontine angle tumors, and demyelinating diseases in the posterior fossa. Functional MRI also offers insights into the vestibular system’s functional aspects. The review emphasizes the increasing importance of imaging diagnostics in the effective management of vestibular system diseases, highlighting both structural and functional imaging modalities to improve patient outcomes.

We report the case of somatosensory evoked potential loss during a transforaminal interbody fusion during exposure following a transient rise in blood pressure. The topography of signal loss and elimination of technical causes led to the inference of left sided stroke which was confirmed as a left thalamocapsular hemorrhagic infarct on postoperative magnetic resonance imaging. Use of intraoperative neuromonitoring in this lumbar fixation surgery helped to identify it intraoperatively and prevented undue alternative surgical decision making.