2022 Volume 115 Issue 2 Pages 99-105
We report three cases of central vertigo that were initially suspected as cases of acute peripheral vertigo at the department of internal medicine and by an otorhinolaryngologist, respectively. Case 1 was an 85-year-old man who presented with a history of rotatory vertigo and vomiting. A head CT revealed no abnormalities. He had positional nystagmus towards the left side, but no positive cranial signs. On the day after hospitalization, while his symptoms disappeared, the nystagmus persisted. Central vertigo was suspected. MRI revealed a cerebellar infarction in the territory of the left medial branch of the posterior inferior cerebellar artery. Case 2 was a 39-year-old man who presented with a history of rotatory vertigo and numbness in the left arm. A head CT and MRI revealed no abnormalities. He had spontaneous nystagmus toward the left side and also positional nystagmus towards the left side. On the 3rd day of hospitalization, the numbness in his left arm gradually spread to the left lower limb. Diffusion-weighted MRI performed about 56 hours after the onset of the rotatory vertigo and numbness in the left arm revealed right medial medullary infraction. The diagnosis in this case was difficult, because of the atypical features and the absence of abnormalities in the initial MRI. Case 3 was a 58-year-old man who presented with a history of rotatory vertigo. Physical examination revealed direction-changing ageotropic positional nystagmus. The patient was referred to our department by an otorhinolaryngologist with suspected benign paroxysmal positional vertigo (BPPV). CT showed left cerebellar hemorrhage. We should be aware of cerebellar disorder as a possible cause of vertigo in cases with nystagmus mimicking the pattern seen in BPPV.
