Peripheral etiologies include benign paroxysmal positional vertigo, labyrinthitis, Meniere’s disease, vestibular neuritis, and acoustic neuroma. Peripheral vertigo generally lacks neurologic findings, although there may be tinnitus (i.e., perception of ringing in ears) or decreased hearing. In this type of vertigo, nystagmus is classically horizontal with symptoms exacerbated by head position. 2 Peripheral vertigo is generally characterized by sudden onset and severe intensity which last seconds to minutes. 2 Clinicians can evaluate symptom onset, intensity, duration, direction of nystagmus (i.e., involuntary eye movement), associated neurologic findings and auditory findings as well as positional effect. 1 A first step in evaluating a patient with vertigo is distinguishing between central and peripheral etiologies. Vertigo has been defined as a pathologic illusion of movement. Vertigo is a common complaint in patients presenting to the emergency department, as well as other outpatient settings. Implementing this strategy may decrease morbidity and mortality associated with cerebellar infarctions. When differentiating benign forms of vertigo from cerebellar infarcts or other central causes, the clinician should take into account risk factors such as central symptoms including neurologic deficits and severe ataxia. Imaging subsequently revealed the patient to have sustained a cerebellar infarct. On initial exam, he had no focal neurologic deficits but did have other concerning symptoms including severe ataxia. The following case report discusses a male in his late twenties with the chief complaint of vertigo. Up to 10% of patients with cerebellar infarctions, however, present to the emergency department with vertigo and no focal neurologic deficits. Classic signs of a cerebellar infarct include symptoms suggestive of central vertigo with focal neurologic deficits on physical exam. Although ruling out these types of fatal diagnoses is essential for emergency medicine physicians, this task can be especially complicated. Although most patients with vertigo, especially younger patients, will have a benign disorder, up to 3% of such patients will have a cerebellar infarct. It can be a manifestation originating from several different disease processes. Pseudotumoral infarcts are responsible for the development of increased pressure within the posterior fossa and intracranially and may mimick posterior fossa tumors.Vertigo is a common complaint in patients who present to the emergency department. Dysarthria is a characteristic symptom of SCA territory infarction. Cerebellovestibular signs are prominent in patients with partial occlusion of the SCA territory.
The SCA infarcts often provoke edema with brainstem compression and herniation of the cerebellar tonsils. The most common symptoms are vertigo or dizziness, vomiting, abnormal gait, headache, and dysarthria. The clinical presentation of ischemia in the territories of the various cerebellar arteries depends on whether the ischemia affects only the cerebellum, only the brainstem, or a combination of brainstem and cerebellum. Cerebellar infarcts are often characterized by associated non-specific symptoms, transposing into clinical conditions difficult to diagnose. The most common locations for cerebellar infarcts are the posterior inferior cerebellar artery (PICA) and superior cerebellar artery (SCA) territories and they are about equally involved.
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