Brain Disorders and Therapeutics

In generally, the symptoms of vertigo syndromes overlap with cerebellar stroke, and approximately 0.7-3% of isolated vertigo have cerebellar stroke. The clinical diagnosis is an important modality, because the computed tomography is 26% sensitive for acute stroke. Vertigo is defined as a pathologic illusion of movement. Most commonly experienced as a spinning sensation, it arises from a pathologic imbalance in the peripheral or central vestibular system. Benign paroxysmal positional vertigo is a distinct condition not typically confused with cerebellar infarction. The paroxysms of intense symptoms lasting less than a minute are defining, as is positional provocation. Meniere’s disease is suspected in the patient who presents with simultaneous vertigo and cochlear complaints. Episodes commonly last a few hours, although they can range from 20 minutes to a few days. Formal diagnosis requires hearing loss documented on audiologic examination on at least one occasion and patients may have normal audiologic examination between episodes. The migrainous vertigo appears to be like an aura that lasts for a few minutes (18%), but for others the vertigo lasts for longer than 24 hours (27%). Physical examination should reveal a normal neurologic examination. Formal diagnostic criteria for migrainous vertigo have been proposed: 1) recurrent episodes of vertigo; 2) a formal migraine diagnosis by I.H.S. criteria; 3) a migraine symptom during the attack (headache, photophobia, or aura) and 4) the exclusion of other causes. Vestibular neuritis is characterized by the acute vestibular syndrome, caused by decreased vestibular tone on one side and reveals a gradual onset. The cerebellar stroke tends to present with the sudden onset of symptoms, usually reaching maximal intensity at once. Vascular risk factors raise the prior probability of disease and the severe ataxia is considered a sign of central vertigo. The direction-changing nystagmus is an important sign of cerebellar stroke.