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Medline ® Abstract for Reference 12

of 'Vestibular neuritis and labyrinthitis'

Cerebellar infarctions mimicking acute peripheral vertigo: how to avoid misdiagnosis?
Casani AP, Dallan I, Cerchiai N, Lenzi R, Cosottini M, Sellari-Franceschini S
Otolaryngol Head Neck Surg. 2013 Mar;148(3):475-81. Epub 2013 Jan 10.
OBJECTIVE: To determine the prevalence of cases of missed cerebellar stroke mimicking acute peripheral vertigo (APV), the so-called pseudo-APV, and to identify the clinical indicators useful for differentiating APV from cerebellar infarction that presents as isolated vertigo.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary referral center.
SUBJECTS AND METHODS: We conducted a retrospective chart review of cases of missed cerebellar infarction over the past 5 years. All patients had first undergone an otoneurological evaluation and computed tomography brain scan in the emergency department before a complete bedside examination was performed in our otoneurological unit.
RESULTS: We identified 11 patients with pseudo-APV (2.8% of all the cases presenting to our unit complaining of acute vertigo). Spontaneous nystagmus (of central type in 2 cases) was recorded in all patients. The Head Impulse Test was clearly negative in 9 cases. The duration of vertigo lasted more than 72 hours in 7 patients. In 4 patients, delayed neurological signs followed acute vertigo 2 to 3 days after the onset. Magnetic resonance imaging showed 8 cases of infarction in the posterior-inferior cerebellar artery territory; in 1 patient, an involvement of the anterior-inferior cerebellar artery territory was recorded; 2 patients showed a hemispheric ischemic cerebellar involvement.
CONCLUSIONS: Pseudo-APV is not an uncommon diagnosis in otoneurological practice. The presence of moderate-severe imbalance and the persistence of vertigo for more than 72 h from the onset, together with the results of bedside examination tests (spontaneous nystagmus and Head Impulse Test), are useful indicators for recognizing a cerebellar ischemic origin in cases of acute vertigo.
Department of Neurosciences, Otorhinolaryngology Unit, Pisa University Hospital, Pisa, Italy. a.casani@med.unipi.it