Cerebellar infarction – a presentation of vertigo

Abstract

The differential diagnosis of acute vertigo includes cerebellar infarction. In the past a mortality rate of 50% - 80% was reported with cerebellar infarction. This is no doubt related to an inability to accurately diagnose small lesions which carry a better prognosis. The advent of computerized tomography (CT) now permits accurate diagnosis of small cerebellar infarctions. Seven patients admitted with acute onset of vertigo which mimicked a peripheral labyrinthine disorder are presented. In all patients a cerebellar etiology was demonstrated by CT. One patient had been subjected to therapeutic labyrinthectomy; three of seven patients had associated unilateral hearing loss suggesting partial brain stem involvemtation. Computerized tomography should be included in the routine work-up of acute vertigo with any associated neurologic findings to aid in proper diagnosis and effect appropriate treatment.

Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome

“…6,[26][27][28][31][32][33] In aggregate, focal neurologic signs were present in 80% (n = 185/230), but diagnostic ascertainment bias in patients with obvious neurologic signs likely makes this proportion a substantial overestimate.…”

“…The tests included pure-tone audiometry, 9,10,27,28 brainstem auditory evoked potentials, 34 or electro-oculography to quantify smooth-pursuit eye movements, 9,10 saccades, 10 optokinetic nystagmus, 10 or caloric responses. 9,10,[26][27][28]33 However, the number of studies reporting on these tests that had a reference standard rated as medium or high quality to rule in or rule out stroke was insufficient to estimate pooled test statistics for predicting central causes of acute vestibular syndrome (AVS).…”

Infarto cerebelar: análise de 151 pacientes

“…A importância desse re g i s t ro é o fato de dois desses pacientes terem evoluído para o tratamento cirúrgico, o que torna necessária a re a l i z a ç ã o de, pelo menos, uma tomografia de encéfalo nos indivíduos com tal sintomatologia, fre q ü e n t e m e n t e medicados e dispensados no pronto socorro. A necessidade do exame ocorre principalmente naqueles em que a sintomatologia persiste por mais de 24 horas a despeito do uso de sintomáticos 8,11,12 .…”

Classification of vestibular brainstem disorders according to vestibulo-ocular reflex planes

“…Small infarctions in the territory of either the anterior inferior cerebellar artery (AICA) or the posterior inferior cerebellar artery (PICA) have been repeatedly reported to mimic unilateral peripheral labyrinthine disorder, mostly with a similarly benign course [7,13]. Hopf [11] described cases with additional impairment of the masseter reflex and argued that a small region ventro-lateral to the floor of the fourth ventricle can be causative because structures serving both vestibular and trigeminal motor functions are present in this area.…”