Isolated acute vertigo in the elderly; vestibular or vascular disease?
BACKGROUND
Elderly patients with isolated acute vertigo are commonly encountered in clinical practice, but little is known about the underlying cause of the symptoms.


METHODS
We prospectively studied 24 patients aged 50-75 years with the acute onset of isolated vertigo lasting > 48 h and no abnormality on neurological examination other than nystagmus. The study protocol included neuro-imaging (MRI 22 patients, CT 2 patients), Doppler sonography, and electro-oculography.


RESULTS
MRI/CT showed the presence of an infarction of the caudal cerebellum in six patients (25%), 3 of whom had a potential cardioembolic source and normal Doppler sonography findings, whereas 3 patients had ipsilateral vertebral artery occlusion and normal cardiac findings. MRI of the posterior fossa was normal in 18 patients. On electro-oculography, ataxic pursuit eye movements was a characteristic finding in patients with cerebellar infarction, whereas caloric test findings were not discriminative.


CONCLUSIONS
A caudal cerebellar infarction may easily be misdiagnosed clinically as a labyrinthine disorder, and was found to be the cause in one fourth of patients presenting with isolated acute vertigo.
Norrving
B
B
Department of Neurology, University Hospital, Lund, Sweden.
Magnusson
M
M
Holtås
S
S
D000208:Acute Disease; D001259:Ataxia / Q000209:etiology / Q000503:physiopathology; D002150:Caloric Tests; D002531:Cerebellum / Q000000981:diagnostic imaging / Q000503:physiopathology; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000503:physiopathology; D003937:Diagnosis, Differential; D007758:Ear, Inner / Q000503:physiopathology; D004585:Electrooculography; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial; D014717:Vertigo / Q000175:diagnosis / Q000209:etiology*; D015837:Vestibular Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology