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J Korean Bal Soc > Volume 5(2); 2006 > Article
Journal of the Korean Balance Society 2006;5(2): 229-234.
말초성 어지러움과 유사한 임상양상을 보이는 소뇌경색환자에 대한 임상적 교찰
이승석, 반재호, 박치열, 이노희, 이종규
성균관대학교 의과대학 강북삼성병원 이비인후과학교실
Clinical Manifestations of Cerebellar Infarction Mimicking Unilateral Vestibulopathy
Seung Suk Lee, Jae Ho Ban, Chee Yeul Park, No Hee Lee, Jong Kyu Lee
Department of Otolaryngology, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. miffy@hananet.net
Background and Objectives:   Pseudo-labyrinthine symptom without any other accompanying neurologic symptoms or signs occur with cerebellar infarction. The prognosis and management of cerebellar infarction differ from those of vertigo associated with unilateral vestibulopathy. The objective of study was to analyze the clinical symptoms of cerebellar infarction mimicking unilateral vestibulopathy according to the infarction territory.
Materials and Method:   Among 273 patients who showed pseudo-labyrinthine symptoms or signs, 28 patients were diagnosed cerebellar infarction on MRI between January 2003 and October 2006. Out of the 28 patients, 9 patients accompanying with focal neurologic symptoms or signs in early stage were excluded, and a retrospective analysis of total 19 patients was done through chart reviews. Using diffusion-weighted imaging, we divided 19 patients into two groups, AICA and PICA territory infarction. Clinincal features, outcome of audiologic and vestibular function test were compared between the groups.
Results:   Among the 19 subjects, 10 were males and 9 were females, the mean age was 63.1±4.0. On MRI, 5 (26.3%) subjects showed infarction in unilateral AICA territory, 14(73.7%) in unilateral PICA territory. In the patients with AICA territory infarction, audiological tests confirmed unilateral sensorineuronal hearing loss in all 5 subjects. On V-ENG, 4/5 (80%) demonstrated horizontal or mixed horizontal torsional spontaneous nystagmus, and 4/5 (80%) had a canal paresis to caloric stimulation. In several days of hospital stay, 3/5 (60%) showed new neurologic signs, facial numbness. In the patients with PICA infarction, there was no hearing change. On V-ENG, 12/14(85.7%) demonstrated horizontal or mixed horizontal torsional spontaneous nystagmus, and 7/14 (50%) had a canal paresis to caloric stimulation. In several days of hospital stay, 10/14 (71.4%) accompanied with cerebellar ataxia.
Conclusion:   Cerebellar infarction simulating unilateral vestibulopathy is more common than previously thought. Early recognition of the cerebellar infarction showing pseudo-vestibular symptom may allow specific management. Also taking into account that clinical features differ by infarction territory will assist in determining the patient’s status of the disease. Key Words : Cerebellum, Infarction
Keywords: Cerebellum; Infarction
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