Postural vertigo and impaired vasoreflexes caused by a posterior inferior cerebellar artery infarct.

Abstract

Central vertigo can have positional characteristics that resemble the positional vertigo of peripheral origin.1 We observed a patient with vertigo that was triggered by orthostasis and likely caused by transiently impaired baroreflex function and cerebral autoregulation after a posterior inferior cerebellar artery (PICA) infarct. A 57-year-old man developed transient nausea, vomiting, vertigo, and diplopia that resolved within 10 minutes. Subsequently, he started to experience spells of intense vertigo every time he stood up. While supine, his blood pressure (BP) was 160/70 mm Hg, and his pulse was 65 beats/minute. The neurologic and neurotologic examination was unremarkable. Head- and neck-positioning maneuvers did not elicit any signs or symptoms. After standing up, however, BP dropped to 118/60 mm Hg, and pulse increased to 75 beats/minute. Within 20 to 30 seconds, he developed vertigo, left lateropulsion, and brisk right-beating horizontal nystagmus. The symptoms subsided within 20 seconds of recumbence. Brain MRI revealed an acute infarct in the right medial branch of PICA territory, involving the inferior cerebellum and the posterior medulla (figure, A). Cerebral angiography showed a right vertebral artery (VA) …