Difficulty in initial diagnosis of cerebellar infarction

Abstract

Generally, the majority of patients who complain of acute vertigo or dizziness end up being misdiagnosed with peripheral labyrinthine disorders in the emergency room and critical care center. Some patients with cerebellar infarcts are likely to be overlooked if imaging studies are not performed. The usual course of cerebellar infarction is benign; however, it may develop mass effect and cause brainstem compression, acute hydrocephalus, which could result in serious morbidity and mortality. Therefore, it is essential to differentiate cerebellar infarction from peripheral vertigo. However, it is difficult to precisely diagnose a patient who demonstrates isolated vertigo, particularly in an emergency room. Head MRI is required for the final confirmation of the diagnosis; however, some patients with acute stroke show no abnormal signal intensity on diffusion-weighted MR image in acute phase. We analyzed 50 patients with cerebellar infarction and assessed clinical features such as the involved vascular territories of cerebellar infarction. It was found later that 11 cases with cerebellar infarction were misdiagnosed at the initial stage. To distinguish between cerebellar infarction and peripheral vertigo is not always easy. During the examination, careful assessment of truncal ataxia as well as limb ataxia along with repeated examinations of head imaging is indispensable even if the initial CT or MRI does not find anything particularly noticeable.