Posterior Inferior Cerebellar Artery Stenosis Presenting as Recurrent Orthostatic Dizziness

Abstract

We report a unique case of vertebrobasilar transient ischemic attacks manifesting as isolated, recurrent, orthostatic dizziness with posterior inferior cerebellar artery (PICA) stenosis. A 57-year-old male patient without past medical history, presented with brief orthostatic dizziness for 2 weeks. There was no associated nausea, vomiting, diplopia, or weakness. On neuro-otologic examination, the patient did not show spontaneous, positional, or gaze-evoked nystagmus. Vestibular function tests such as caloric test, head impulse test, video-oculography, and tilt table test were normal. Brain diffusion-weighted images showed multiple small high signal intensities in the bilateral cerebellar hemispheres. Brain magnetic resonance angiography revealed hypoplasia of the right vertebral artery without focal intracranial focal stenosis. Four-vessel cerebral angiogram showed severe stenosis at the right PICA artery. Our patient’s clinical scenario appears unique hemodynamic spells without symptoms or signs of posterior circulation ischemia. Physicians should also consider cerebrovascular ischemic when the patient suffers repeated orthostatic dizziness that is not explained clinically.