A case of the cerebellar infarction appears findings of peripheral vertigo in the HINTS plus

Abstract

Acute Vestibular Syndrome (AVS) is defined by its signs and symptoms: vertigo, nystagmus, nausea, head-motion intolerance or gait disorder. HINTS plus (Head Impulse test, Nystagmus, Test of Skew and audiometry) is a set of examination for stroke diagnosis in patients with AVS. A 4-step bedside oculomotor examinations appears more sensitive for stroke than early MRI in AVS. We report a case of cerebellar infarction with vertigo that could not be diagnosed by HINTS plus.

Case: A male in his eighties was brought to our hospital due to vertigo, walking difficulty and vomiting. He had hypertension and interstitial pneumonia. He presented with normal consciousness and slight hypertension. Although HINTS plus test indicated peripheral vertigo, he had cerebellar ataxia. So MRI was performed which revealed cerebellar infarction.

Consideration: This case showed a left vertebral artery occlusion that affected dysfunction of vestibular nuclei. We assume this dysfunction influenced by Posterior inferior cerebellar artery occlusion, then the abnormal vestibular-ocular reflex appeared.

Conclusion: In diagnosing central vertigo, not only HINTS plus examination, but also other neurological findings, should be taken into consideration.