Isolated acute vertigo in the elderly; vestibular or vascular disease?

INTRODUCTION: Elderly patients with isolated acute vertigo are commonly encountered in clinical practice, but little is known about the underlying cause of the symptoms.

MATERIAL & 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.

CONCLUSION: 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.