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

Acta Neurol Scand. 1995 Jan;91(1):43-8. doi: 10.1111/j.1600-0404.1995.tb05841.x.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Ataxia / etiology
  • Ataxia / physiopathology
  • Caloric Tests
  • Cerebellum / diagnostic imaging
  • Cerebellum / physiopathology
  • Cerebrovascular Disorders / complications*
  • Cerebrovascular Disorders / physiopathology
  • Diagnosis, Differential
  • Ear, Inner / physiopathology
  • Electrooculography
  • Female
  • Frontal Lobe / physiopathology
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Occipital Lobe / physiopathology
  • Tomography, X-Ray Computed
  • Ultrasonography, Doppler, Transcranial
  • Vertigo / diagnosis
  • Vertigo / etiology*
  • Vestibular Diseases / complications*
  • Vestibular Diseases / diagnosis
  • Vestibular Diseases / physiopathology