J Korean Med Assoc.  2008 Nov;51(11):1016-1024. 10.5124/jkma.2008.51.11.1016.

Vertigo due to Stroke

• Lee H
• Kim JI

• KMID: 2137744
• DOI: http://doi.org/10.5124/jkma.2008.51.11.1016

Abstract

Episodic vertigo frequently occurs in patients suffering from transient ischemia in the distribution of the vertebrobasilar circulation (i.e., vertebrobasilar insufficiency). It may occur in isolation, with other symptoms of vertebrobasilar insufficiency or with persisting symptoms and signs of the infarction of the brain stem and/or cerebellum. Typical attacks of ischemic vertigo are abrupt in onset and last minutes. Ischemic stroke in the distribution of posterior circulation commonly develops acute onset of spontaneous prolonged vertigo and imbalance. As many as 25% of patients with risk factors for stroke who present to an emergency medical setting with isolated, severe vertigo, nystagmus, and postural instability have an infarction of the caudal cerebellum (i.e., pseudo-vestibular neuritis). Since the head thrust test can be performed at the bedside with no requirement of special equipments, it is invaluable for separating 'pseudovestibular neuritis' from true vestibular neuritis. Physicians who evaluate stroke patients should be trained to perform and interpret the result of the head impulse test. Since the inner ear is supplied by the vertebrobasilar circulation, inner ear symptoms are common with ischemia in the distribution. We briefly reviewed the clinical symptoms and neurological examinations of stroke presenting with vertigo, especially focusing on ischemic stroke of the vertebrobasilar territory.

Keyword

Vertigo; Stroke; Vertebrobasilar artery

MeSH Terms

Brain Stem
Cerebellum
Ear, Inner
Emergencies
Head
Humans
Infarction
Ischemia
Neurologic Examination
Risk Factors
Stress, Psychological
Stroke
Vertebrobasilar Insufficiency
Vertigo
Vestibular Neuronitis

Figure

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  Figure 1 Vascular supply of the inner ear.

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  Figure 2 Schematic view of connections responsible for saccadic lateropulsion. The climb-ing fibers originating from the contralateral inferior olive terminate in lobule VII of cerebellar cortex with an inhibitory action. In turn, these Purkinje cells in-hibit ipsilateral fastigial nucleus cells. Finally, the output of ipsilateral fastigial nucleus activates the contralateral paramedian pontine reticular formation, through the uncinate fasciculus. 1. medial medullary syndrome. 2. lateral medullary syndrome. 3. superior cerebellar artery syndrome.

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