1/9. Embolic cerebellar infarction caused by spontaneous dissection of the extracranial vertebral artery--two case reports.Spontaneous dissection of the extracranial vertebral artery (VA) may cause ischemic stroke in the posterior circulation. A 22-year-old female and a 38-year-old male presented with sudden onset of vertigo and nausea without trauma. Angiography was initially interpreted as normal, but retrospective examination disclosed extracranial VA dissection in the V3 segment in both cases. Arterial dissection resulting in embolic stroke in the territory of the ipsilateral posterior inferior cerebellar artery was highly suspected. Both patients were treated conservatively without sequelae. Careful angiographic interpretation is important for the diagnosis of extracranial VA dissection. Spontaneous extracranial VA dissection should be suspected in young patients presenting with ischemic stroke but without predisposing risk factors or associated trauma.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
2/9. Chronic isolated vertigo.vertigo can be the first manifestation of vertebrobasilar ischaemia or brainstem and cerebellar stroke. Chronic isolated vertigo may pose a diagnostic dilemma. We report the case of a patient who presented with chronic isolated vertigo, and highlight the clinical use of magnetic resonance imaging and angiography in his management.- - - - - - - - - - ranking = 6keywords = vertigo (Clic here for more details about this article) |
3/9. Recurrent arachnoid cyst of Meckel's cave mimicking a brain stem ischaemia. Report of a rare case.A 44-years old man developed TIA-like symptoms with dysaesthesia around the mouth, vertigo and diplopia. MRI revealed a cystic space-occupying lesion on the right Meckel's cave, which spread out into cerebellopontine angle in a further examination. Therefore surgical exploration was performed using a suboccipital approach. An arachnoidal cyst was found and removed including its wall. About three months later the patient suffered again from dysaesthesias of the right side of the face and a new MRI revealed a recurrence of the lesion, with extension into the cerebellopontine angle, too. Surgical revision was done using the same approach and the recurrent cyst was removed. Postoperatively, there were a transient hypaesthesia in the distribution area of the right trigeminal nerve and a light pulmonary embolism occurred as a complication. No symptoms have returned during an observation period of 15 months. CONCLUSION: An arachnoidal cyst must be considered as a rare cause, when a lesion is found at the Meckel's cave with intermittent clinical symptoms of a trigeminal nerve affection. As surgical treatment we favour fenestration and cyst wall resection.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
4/9. Differences in diffusion-weighted and T2-weighted magnetic resonance imaging findings in the acute and chronic stages of ischemic cerebrovascular disease--two case reports.A 71-year-old man presented with sudden onset of vertigo and a 77-year-old man suffered consciousness disturbance. diffusion-weighted magnetic resonance (MR) imaging on admission showed hyperintense areas in the left cerebellar hemisphere in the first patient and in the brainstem in the second patient. Both patients were treated with argatroban and edaravone, and the neurological deficits markedly improved one month after admission. T2-weighted MR imaging one month after the onset showed much smaller hyperintense areas compared with the findings on admission in both patients. These results indicate that findings of hyperintense areas by diffusion-weighted MR imaging in the acute stage of ischemic cerebrovascular disease indicate not only the ischemic core but also parts of the reversible incomplete ischemic lesion and suggest that intensive treatment in the acute stage might reverse ischemic brain damage in some patients.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
5/9. vertebral artery dissection as a rare cause of vertigo: case report.vertebral artery dissection is one of the more frequent cerebral-vascular disorders in the young adult. The initial symptoms rarely consist of vertigo with clinical characteristics of Selective Monolateral Acute Vestibular Deficit syndrome. The case is described of a patient, who arrived with intense rotatory vertigo associated with neurovegetative symptoms and spontaneous nystagmus, which we initially diagnosed as right neuronitis. About 48 hours later, the symptoms of vertigo disappeared spontaneously, and prevalently nuchal cephalea appeared. Since the symptoms were atypical and the otoneurologic study revealed normal canalar and otholithic function, a cerebral nuclear magnetic resonance, with contrast, was carried out which showed the presence of multiple areas of cerebellar ischaemia, prevalently on the left, and at the level of the right occipital lobe. Study of the patient was completed with an intracranial angio-nuclear magnetic resonance of the neck arteries and cerebral angiography the findings of which were compatible with left vertebral artery dissection. It is important to emphasize, as reported in the literature, that in cases in which atypical evolution of the pathology appears, or instrumental data do not confirm initial suspicions, a more scrupulous study is always necessary in order to find a possible central cause. Among the central causes, it should not be forgotten that multiple small cerebellar strokes (more frequent in elderly patients) and even more rarely also vertebral artery dissection (which is typical of younger patients) may become evident in a clinical picture that is almost identical to that seen in selective monolateral acute vestibular deficit syndrome.- - - - - - - - - - ranking = 7keywords = vertigo (Clic here for more details about this article) |
6/9. brain stem ischemia from intracranial dural arteriovenous fistula: case report.BACKGROUND: Intracranial dural arteriovenous fistulas (AVFs) with spinal perimedullary venous drainage are rarely reported, but most of the patients initially have presented with myelopathy or subarachnoid hemorrhage. This is the first report of the intracranial dural AVF patient who presented with brain stem infarction. CASE DESCRIPTION: A 38-year-old woman experienced nausea and vomiting with an acute onset, followed by vertigo. magnetic resonance imaging showed ischemic lesion in the medulla oblongata, and she was then sent to our hospital. On admission, she had nystagmus, swallowing difficulties, Homer syndrome, and right hemiparesis and hemisensory disturbance. cerebral angiography revealed dural AVF draining into spinal perimedullary veins at the left transverse-sigmoid sinus. The patient was treated by transvenous embolization under local anesthesia. A microcatheter proceeded to the left sigmoid sinus via the internal jugular vein, and embolization of the sinus was performed using coils without complications. The patient's swallowing difficulties improved over a few days after the embolization, and one month later, there remained only a slight mild hemiparesis and hemisensory disturbance. Six months after the onset, there was no ischemic lesion in the brain stem on magnetic resonance imaging. CONCLUSIONS: In this case, we showed the possibility of brain stem infarction, caused by the intracranial dural AVF.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
7/9. Excision and end-to-end anastomosis of a fusiform aneurysm of the distal posterior inferior cerebellar artery associated with ischemia--case report.A 35-year-old male with a sudden onset of severe vertigo and vomiting had a fusiform aneurysm of the distal portion of the left posterior inferior cerebellar artery. The symptoms were caused by cerebellar infarction probably due to an embolism from the aneurysm. The aneurysm was excised and the artery reconstructed by end-to-end anastomosis with an excellent outcome. Histological examinations showed mural thrombus but no wall dissection.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
8/9. Cerebrovascular complications of Fabry's disease.Fabry's disease (FD) is a rare, sex-linked disorder resulting from alpha-galactosidase deficiency. Cerebrovascular complications have been reported in the literature but have not been systematically analyzed. We report 2 patients and review 51 previously reported cases (descriptive meta-analysis) to clarify the clinical, radiologic, and pathologic features. The average age at onset of cerebrovascular symptoms was 33.8 years for hemizygous individuals (n = 43) and 40.3 years of heterozygotes (n = 10). The most frequent symptoms and signs were as follows (in descending order of frequency): hemiparesis, vertigo/dizziness, diplopia, dysarthria, nystagmus, nausea/vomiting, head pain, hemiataxia, and ataxia of gait, in the hemizygote group; and memory loss, dizziness, ataxia, hemiparesis, loss of consciousness and hemisensory symptoms, in the heterozygote group. The vertebrobasilar circulation was symptomatic in 67% of the hemizygotes and 60% of the heterozygotes. Intracerebral hemorrhage was found in 4 patients (3 hemizygotes and 1 heterozygote). Elongated, ectatic, tortuous vertebral and basilar arteries were the most common angiographic and pathologic features. For the hemizygotes, the recurrence rate for cerebrovascular disease was 76% and the death rate was 55%; 86% of the heterozygotes had recurrent cerebrovascular event(s) and 40% died. The cerebrovascular manifestations of FD, in both hemizygotes and heterozygotes, are predominantly due to dilative arteriopathy of the vertebrobasilar circulation, frequently recur, and portend a poor prognosis.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
9/9. Isolated vertigo as a manifestation of vertebrobasilar ischemia.OBJECTIVE: We sought to demonstrate that isolated episodes of vertigo can be the only manifestation of vertebrobasilar ischemia. BACKGROUND: Isolated persistent vertigo is classically ascribed to labyrinthine disorders and is only rarely considered to reflect vertebrobasilar ischemia. methods: We retrospectively analyzed all of the records of the Saint Louis University stroke Registry between January 1, 1992 and September 1, 1993. We set out to identify those patients discharged with a diagnosis of transient ischemic attack (TIA) in the vertebrobasilar system. We reviewed their clinical records and the results of their diagnostic studies. RESULTS: We screened 600 admissions and found 29 patients with vertebrobasilar circulation TIAs. Of these, five men and one woman had episodic vertigo for at least 4 weeks as their only presenting symptom. All six patients had one of two abnormal patterns on magnetic resonance angiography (MRA): focal basilar stenosis or widespread vertebrobasilar slow flow. In three patients, the MRA findings were confirmed by cerebral angiography. Five patients were treated with warfarin and one with aspirin. Two patients developed brainstem infarctions, one of them fatal. CONCLUSIONS: Isolated vertigo can be the only manifestation of vertebrobasilar ischemia. Its frequency may be underestimated in clinical practice. Noninvasive testing is helpful both for diagnosis and follow-up.- - - - - - - - - - ranking = 8keywords = vertigo (Clic here for more details about this article) |