2023 Volume 82 Issue 3 Pages 201-208
Vertigo patients with persistent direction-fixed nystagmus in the absence of hearing impairment are often diagnosed as cases of vestibular neuritis. In reality, however, cerebrovascular disorders account for 2.8% to 7% of cases of vertigo, and the possibility of central vertigo should always be kept in mind. In this report, we describe three cases with a final diagnosis of central vertigo in which the initially suspected diagnosis was vestibular neuritis. Case 1 was a case of Wallenberg syndrome due to dorsolateral infarction of the right medulla oblongata. Case 2 was a case of multiple cerebral infarction (medulla oblongata and cerebellum) also manifesting various other symptoms, including ataxia of the trunk, diplopia, right bias, numbness of the hands, and speech disorder. Case 3 was a case of MLF syndrome with ocular adduction disorder and rotatory nystagmus; the infarct site was at the level of the midbrain to pons on the affected side. All three patients had dizziness with constant directional nystagmus, which was diagnosed as being derived from vestibular neuritis at the time of the initial examination. Especially in cases with suspected brainstem or cerebellar symptoms, such as sensory disturbances, eye movement disorder, and trunk ataxia, it is important to make every effort to rule out central vertigo.
