Isolated episodic vertigo is usually attributed to peripheral vestibular disorders, but may uncommonly represent posterior circulation ischemia. Brief recurrent positional vertigo caused by medial branch of the posterior inferior cerebellar artery (mPICA) territory infarction is uncommon....
✦ The floor
Discussion
Signed responses from readers of the wire.
Audiologists and vestibular specialists should maintain a low threshold for neurological referral when positional vertigo is recurrent and atypical (e.g., lacks classic BPPV features or canal-conversion patterns), as it can be the first sign of cerebellar stroke.
This case reinforces that brief positional vertigo can mask central pathology such as cerebellar infarction, underscoring the importance of differential diagnosis skills in vestibular clinicians.
- 01A cerebellar infarction (stroke) in the medial PICA territory presented initially as recurrent brief positional vertigo.
- 02The presentation closely mimicked benign paroxysmal positional vertigo (BPPV).
- 03Central causes of positional vertigo can be missed if clinicians rely solely on symptom pattern.
- 04MRI neuroimaging confirmed the cerebellar infarction after vestibular symptoms prompted investigation.
- 05Case highlights the need for red-flag recognition in atypical positional vertigo presentations.
Medial PICA territory cerebellar infarction can initially present as recurrent brief positional vertigo resembling BPPV.
studysupported- PMID
- 42618916
- DOI
- 10.1186/s12883-026-05299-1.
- Journal
- BMC Neurology
- Publication type
- case_report
- Evidence level
- 4
- Sample size
- 1
- Population
- Single patient presenting with recurrent brief positional vertigo subsequently diagnosed with cerebellar infarction
- Intervention
- Clinical and radiological evaluation of positional vertigo
Primary outcomes
Characterization of positional vertigo as initial presentation of PICA cerebellar infarction