Abstract
We report herein on a 16-year-old man with acute disseminated encephalomyelitis (ADEM) who presented with rotatory vertigo. Initially, we suspected a peripheral vertigo, such as Meniere's disease, because of the presence of direction-fixed right-beating horizontal-rotatory nystagmus and low-tone sensori-neural hearing loss in his right ear. The positional nystagmus, however, varied with time; left-beating horizontal-rotatory nystagmus was noted on the 2nd day and ageotrophic positional nystagmus on the 13th day of hospitalization. Enhanced brain MRI was performed, because the patient exhibited persistent gait disturbance and headache. High intensity area in FLAIR sequence and a ring-enhanced lesion were detected around the forth ventricle. The neurologist diagnosed ADEM based on the clinical symptoms, feature and course.
No additional treatment was undertaken because the patient recovered spontaneously, and no recurrent symptoms have been observed. However, the ageotrophic positional nystagmus together with MRI lesion remained. It is important to suspect central vertigo such as ADEM, especially when the patient is young and shows gait disturbance.
