Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey.
Neurologist. 2024 Sep 1;29(5):308-309. doi: 10.1097/NRL.0000000000000575.
To draw attention to acute positional vertigo and central positional nystagmus (CPN) developing as the sole features of cerebellar nodulus infarction.
The cerebellar nodulus is vascularized by the medial branch of the posterior inferior cerebellar artery, which also supplies the uvula, tonsil, tuber, and pyramid of the vermis, and the inferior part of the cerebellar hemisphere, making isolated cerebellar nodulus infarction extremely rare. CPN occurs after a change in head position with respect to gravity and is caused by pathologies involving the vestibulo-cerebellar pathways. CPN is rarely seen in isolation. Additional neurological signs and ocular motor abnormalities are generally present.
A 62-year-old man was admitted to the emergency department with acute-onset positional vertigo and CPN as the sole finding on examination. Cranial magnetic resonance imaging revealed an acute infarction involving the nodulus. Results: Infarcts restricted to nodulus can cause positional vertigo and CPN without any associated neurological signs or ocul ar motor abnormalities.
Though very rare, cerebellar nodulus stroke must be searched in patients with positional vertigo of acute onset and isolated CPN on examination.
提请大家注意，小脑小结梗死可仅表现为急性位置性眩晕和中枢性位置性眼球震颤（CPN）。
小脑小结由小脑后下动脉的内侧支供血，该动脉还供应扁桃体、扁桃体、结节和蚓部的锥体以及小脑半球的下部，因此孤立性小脑小结梗死极为罕见。CPN 发生在头部相对于重力的位置改变后，由涉及前庭小脑通路的病变引起。CPN 很少孤立出现，通常伴有其他神经体征和眼球运动异常。
一名 62 岁男性因急性发作的位置性眩晕和检查时仅发现 CPN 而被收入急诊科。头颅磁共振成像显示急性梗死累及小结。
小结内的梗死可引起位置性眩晕和 CPN，而无任何相关的神经体征或眼动异常。
虽然非常罕见，但对于急性起病且检查时仅出现位置性眩晕和孤立性 CPN 的患者，必须寻找小脑小结卒中的可能性。
