Vertigo in brainstem and cerebellar strokes

Abstract

INTRODUCTION Approximately 20% of ischemic events are known to involve the neural structures supplied by the posterior (vertebrobasilar) circulation, and dizziness/vertigo is one of the most common symptoms of vertebrobasilar diseases [1]. In cerebrovascular disorders, the dizziness/vertigo usually accompanies other neurological symptoms and signs. Indeed, medical adage had taught us that isolated vertigo mostly comes from peripheral vestibular diseases. However, isolated vascular vertigo might have been underestimated. With recent developments in clinical neurotology and neuroimaging, diagnosis of isolated vertigo from brainstem and cerebellar strokes has increased markedly (Fig. 1). Furthermore, transient isolated vertigo is the common manifestation of vertebrobasilar insufficiency [2]. It is important to differentiate isolated vertigo of a vascular cause from more benign disorders involving the inner ear since therapeutic strategy and prognosis differ in these two conditions. Misdiagnosis of acute stroke may result in significant morbidity and mortality, whereas overdiagnosis of vascular vertigo would lead to unnecessary costly work-ups and medication.