OBJECTIVE: To determine the prevalence of cases of missed cerebellar stroke mimicking acute peripheral vertigo (APV), the so-called pseudo-APV, and to identify the clinical indicators useful for differentiating APV from cerebellar infarction that presents as isolated vertigo. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: We conducted a retrospective chart review of cases of missed cerebellar infarction over the past 5 years. All patients had first undergone an otoneurological evaluation and computed tomography brain scan in the emergency department before a complete bedside examination was performed in our otoneurological unit. RESULTS: We identified 11 patients with pseudo-APV (2.8% of all the cases presenting to our unit complaining of acute vertigo). Spontaneous nystagmus (of central type in 2 cases) was recorded in all patients. The Head Impulse Test was clearly negative in 9 cases. The duration of vertigo lasted more than 72 hours in 7 patients. In 4 patients, delayed neurological signs followed acute vertigo 2 to 3 days after the onset. Magnetic resonance imaging showed 8 cases of infarction in the posterior-inferior cerebellar artery territory; in 1 patient, an involvement of the anterior-inferior cerebellar artery territory was recorded; 2 patients showed a hemispheric ischemic cerebellar involvement. CONCLUSIONS: Pseudo-APV is not an uncommon diagnosis in otoneurological practice. The presence of moderate-severe imbalance and the persistence of vertigo for more than 72 h from the onset, together with the results of bedside examination tests (spontaneous nystagmus and Head Impulse Test), are useful indicators for recognizing a cerebellar ischemic origin in cases of acute vertigo.
OBJECTIVE: To determine the prevalence of cases of missed cerebellar stroke mimicking acute peripheral vertigo (APV), the so-called pseudo-APV, and to identify the clinical indicators useful for differentiating APV from cerebellar infarction that presents as isolated vertigo. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: We conducted a retrospective chart review of cases of missed cerebellar infarction over the past 5 years. All patients had first undergone an otoneurological evaluation and computed tomography brain scan in the emergency department before a complete bedside examination was performed in our otoneurological unit. RESULTS: We identified 11 patients with pseudo-APV (2.8% of all the cases presenting to our unit complaining of acute vertigo). Spontaneous nystagmus (of central type in 2 cases) was recorded in all patients. The Head Impulse Test was clearly negative in 9 cases. The duration of vertigo lasted more than 72 hours in 7 patients. In 4 patients, delayed neurological signs followed acute vertigo 2 to 3 days after the onset. Magnetic resonance imaging showed 8 cases of infarction in the posterior-inferior cerebellar artery territory; in 1 patient, an involvement of the anterior-inferior cerebellar artery territory was recorded; 2 patients showed a hemispheric ischemic cerebellar involvement. CONCLUSIONS: Pseudo-APV is not an uncommon diagnosis in otoneurological practice. The presence of moderate-severe imbalance and the persistence of vertigo for more than 72 h from the onset, together with the results of bedside examination tests (spontaneous nystagmus and Head Impulse Test), are useful indicators for recognizing a cerebellar ischemic origin in cases of acute vertigo.
Authors: S Vanni; R Pecci; C Casati; F Moroni; M Risso; M Ottaviani; P Nazerian; S Grifoni; P Vannucchi Journal: Acta Otorhinolaryngol Ital Date: 2014-12 Impact factor: 2.124