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Images in Neurology |

Transient Isolated Vertigo Secondary to an Acute Stroke of the Cerebellar Nodulus

Neil E. Schwartz, MD, PhD; Chitra Venkat, MD; Gregory W. Albers, MD
Arch Neurol. 2007;64(6):897-898. doi:10.1001/archneur.64.6.897.
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An 88-year-old woman with diabetes and hypertension presented to the emergency department with acute onset of severe nonpositional vertigo accompanied by nausea and vomiting. There were no other posterior circulation symptoms. Within hours her vertigo resolved. While symptomatic, her examination findings were notable only for poor smooth pursuit, right-beating gaze evoked nystagmus, and a mildly unsteady gait. There was no dysmetria or truncal ataxia. Though suggestive of a peripheral vestibulopathy, her vascular risk factors prompted a brain magnetic resonance imaging scan. This demonstrated restricted diffusion in the cerebellar nodulus, consistent with an acute infarction (Figure, A and B). Mild diffuse irregularities of the anterior and posterior circulation were demonstrated on intracranial MRA (magnetic resonance angiography). A drop out of signal on the time-of-flight MRA was seen in the distal left vertebral artery, suggestive of a focal stenosis; no flow-related enhancement was seen in the left posterior inferior cerebellar artery (Figure, D).

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Brain MRI (magnetic resonance imaging) scan demonstrating areas of restricted diffusion in the cerebellar nodulus on axial (A, arrow) and coronal (B, arrow) sequences. These correspond to regions of hypointensity on the apparent diffusion coefficient maps (not shown). C, The nodulus (arrow) is the most inferior portion of the vermis. D, A time-of-flight intracranial MRA (magnetic resonance angiogram) shows a stenosis in the distal left vertebral artery (arrow) and a lack of flow-related enhancement in the left posterior inferior cerebellar artery.

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