Patients are well until a head movement, usually vertical, precipitates the paroxysm of symptoms. The paroxysms of intense symptoms lasting less than a minute are defining, as is positional provocation. 10 Patients present with brief episodes of intense vertigo, precipitated by a change in position. Central mimics of BPPV have been described, but they tend to be caused by tumors rather than strokes, and are recognized by association with other abnormalities. Finally, we will propose indications for neuroimaging.īenign paroxysmal positional vertigo is a distinct condition not typically confused with cerebellar infarction. 5 Then we will review the physical diagnosis of cerebellar infarction. This review will first address differentiation of cerebellar infarction from the four most common vertigo syndromes: benign paroxysmal positional vertigo (BPPV), Meniere’s disease, migrainous vertigo, and vestibular neuritis. 4 In contrast, important physical signs are present in the majority of patients with cerebellar infarction. Resorting to computed tomography (CT) is insufficient because it is only 26% sensitive for acute stroke. Physical diagnosis is the most important diagnostic modality for cerebellar infarction. Patients with missed cerebellar infarction in general are at higher risk for complications, with a mortality rate possibly as high as 40%. 1, 2 Because the symptoms of cerebellar infarction overlap substantially with benign conditions it is commonly overlooked, with a misdiagnosis rate estimated at 35% 2. While most patients who present to emergency departments (ED) with isolated vertigo have benign disorders, approximately 0.7–3% have cerebellar infarction. The majority of these may have other signs of central vertigo, specifically direction-changing nystagmus and severe ataxia. Approximately 10% of patients with cerebellar infarction present with vertigo and no localizing neurologic deficits. Confirmation of a peripheral vertigo syndrome substantially lowers the likelihood of cerebellar infarction, as do indicators of a peripheral disorder such as an abnormal head impulse test. The differentiation of common vertigo syndromes such as benign paroxysmal positional vertigo, Meniere’s disease, migrainous vertigo, and vestibular neuritis is summarized. Vertigo is defined and identification of a vertigo syndrome is discussed. This article summarizes the emergency department approach to diagnosing cerebellar infarction in the patient presenting with vertigo.
0 kommentar(er)
