Dramatic course of an initial mild dizziness symptoms up to the life-threatening clinical picture

Background The leading symptom of dizziness includes a wide range of differential diagnoses and can always be a challenge for the experienced clinician. Therefore, in the case of dizziness, a multidisciplinary assessment of apparently unambiguous medical conditions must be sought.

Anamnesis/Findings A 55-year-old patient was diagnosed with two weeks of increasing dizziness and vomiting. There was no hypacusis or tinnitus. By means of cMRI, fresh or moderate ischemia or bleeding had been ruled out. The ear microscopy was inconspicuous. Neurootologically, a spontanning stagmus showed to the right, with amplification when looking to the right. The function of the facial nerve was intact, but a clear asymmetry of the eyelid gap on the left was noticeable in a further coarsely orienting neurologically inconspicuous patient.

History In the emergency room, the patient spontaneously deteriorated with newly occurring opthalmoplegia, hypoglossus palsy and nystagmus on all sides. In the case of focal seizures, the patient was required to be intubated. The cCT confirmed the diagnosis of cerebellar infarction on the left.

Conclusion In patients with dizziness, differentially agnostic, a cerebellum infarction should always be considered, since in about 10 % of these cases only dizziness and vomiting occur primarily. Even an initially inconspicuous imaging does not exclude an infarction. The indication of a cerebellum infarction can manifest itself over time and thus become visible to the doctor

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Publication History

Article published online:
10 June 2020