Abstract
Stroke in the distribution of the posterior circulation may present as acute onset
spontaneous vertigo and imbalance. Although vertigo due to posterior circulation stroke
is usually associated with other neurologic symptoms or signs, small infarcts in the
cerebellum or brainstem can present with vertigo without other localizing symptoms.
Approximately 17% of patients with isolated posterior inferior cerebellar artery territory
infarction presented with isolated vertigo, nystagmus, and postural unsteadiness.
A head impulse test can differentiate acute isolated vertigo associated with cerebellar
stroke from more benign disorders involving the inner ear. Sometimes acute isolated
audiovestibular loss can be the initial symptom of impending posterior circulation
ischemic stroke (particularly within the territory of the anterior inferior cerebellar
artery). In this case, evaluation of isolated audiovestibular loss may prevent the
progression of acute vertigo and hearing loss into more widespread areas of infarction
in the posterior circulation. In this article, the clinical syndromes and signs of
acute vestibular syndrome due to posterior circulation stroke involving the brainstem
and cerebellum are summarized.
Keywords
vertigo - stroke - posterior circulation - brainstem - cerebellum