CEREBELLAR INFARCTS VS ACUTE PERIPHERAL VERTIGO: HOW TO AVOID MISDIAGNOSIS- A REVIEW OF LITERATURE

Shaveta Yadav, Narendra Singh Rathore, Guang Yao Wu* and Ning Tu

ABSTRACT

Cerebellar infarcts account for between 1.5% and 3% of all ischemic strokes. Vertigo and imbalance are the most common symptoms in patients with isolated cerebellar infarctions[1,2] and they appear without any other signs of cerebellar dysfunction in approximately 38% of patients.[3] Cerebellar infarcts are one of the common causes of vascular vertigo. APV is a clinical disorder caused by acute unilateral damage of the peripheral vestibular structures, which is characterized by long-lasting (more than 24 hours) rotatory vertigo, spontaneous nystagmus, postural instability, and neurovegetative symptoms without signs of cochlear and brain stem involvement.[4] The diagnosis of cerebellar infarctions can be challenging, as the commonly associated clinical signs and symptoms and the unfound reliance on a negative CT scan[5] may not necessarily alert a physician to a stroke. Misdiagnosis of cerebellar infarct (CI) has not been well documented.[6] There are very few reports regarding the misdiagnosis of cerebellar infarct (CI).[7] Study by Norrving[8], found that approximately one-fourth of patients with vascular risk factors who presented in an emergency medical setting with isolated severe vertigo, nystagmus, and postural instability had an infarct in the territory of the mPICA. Kuroki.[9] reported that 4 of 18 (22%) patients with CI were not diagnosed at first and were misdiagnosed as patients with vertigo. The goal of the present review article is to study how to avoid the misdiagnosis of cerebellar infarct. Diffusion Weighted Imaging (DWI) is considered better than computed tomography (CT) for the diagnosis of infarct but in some cases even DWI may fail to predict an acute infarct and its sensitivity is lower in the posterior fossa as compared to the anterior fossa. A focused bedside HINTS (head impulse, nystagmus, test of skew) examination can identify stroke with high sensitivity and specificity in patients presenting to the emergency department with acute isolated vertigo and is superior to diffusion-weighted magnetic resonance imaging (MRI) during the acute phase.

Keywords: *Cerebellar infarction *MRI *Misdiagnosis