Investigation of 17 patients with central vertigo that began with vertigo

Abstract

Seventeen patients with central vertigo that began with vertigo, seen between 2000 and 2008 at the Department of Otorhinolaryngology of Osaka Medical College Hospital, were investigated. The patients included 14 males and three females. Their mean age was 59.2 years (range 27-82). The cases consist of six cerebellar infarctions, two anterior inferior cerebellar artery (AICA) syndromes, two Wallenberg syndromes, two medial longitudinal fasciculus (MLF) syndromes, three other brain-stem infarctions, one viral encephalitis, and one acute cerebellar ataxia. Thirteen cases (77%) had a history of a disorder that might reduce the cerebral blood flow, and six (46%) had multiple risk factors. The mean interval between the appearance of symptoms and the first visit to our hospital was 6.5 days, and it took 3.8 days to reach a diagnosis. Eleven patients (65%) were transported to hospital by ambulance. Seven (41%) had a delayed neurological abnormality other than vertigo. Nystagmus that was seen at the first visit suggested central vertigo in seven cases and peripheral vertigo in seven cases. In four cases (24%), the nystagmus changed over time, and initially three patients had nystagmus that suggested peripheral vertigo. In some cases, we made the diagnosis based on a neurological abnormality other than vertigo. In other cases, the diagnosis was based on the discordance between the neuro-otological findings and disturbed equilibrium that was inconsistent with peripheral vertigo. When diagnosing central vertigo that began with vertigo, it is important to consider not only neurological abnormalities but also neuro-otological findings and a balance disorder that cannot reasonably be explained as peripheral vertigo.