Aye Hla Hla, Hakim Eluzai
Department of Acute Medicine, University Hospitals Dorset NHS Foundation Trust, Bournemouth, GBR.
Department of Stroke Medicine, University Hospitals Dorset NHS Foundation Trust, Bournemouth, GBR.
Cureus. 2025 Feb 3;17(2):e78403. doi: 10.7759/cureus.78403. eCollection 2025 Feb.
Posterior circulation infarcts (POCI) can present with non-specific symptoms, making diagnosis challenging and often delayed. We present a 58-year-old lady with a history of migraine who attended the emergency department of a district general hospital with sudden onset of vertigo, nausea, and vomiting but without focal neurological deficits. At the initial assessment, she experienced marked dizziness, which was worse on opening her eyes. Unenhanced brain computed tomography (CT) scan as well as CT angiography were normal. A provisional diagnosis of atypical presentation of migraine or benign paroxysmal positional vertigo was made. A stroke physician's opinion was sought, and in view of her persistent symptoms, magnetic resonance imaging (MRI) brain was carried out. This demonstrated three small acute infarcts: one in the posterior left temporal lobe, one in the inferior left occipital lobe, and one in the left cerebellar vermis. Further comprehensive stroke investigations were unremarkable. She was treated with dual antiplatelet therapy and statin. This case highlights the diagnostic challenges of posterior circulation ischaemic stroke and the importance of considering it in patients with unexplained vertigo, particularly those with stroke risk factors (migraine with aura, elevated cholesterol, and family history of stroke in this patient), to prevent misdiagnosis and serious complications.
后循环梗死（POCI）可能表现为非特异性症状，这使得诊断具有挑战性且常常延迟。我们报告一位58岁有偏头痛病史的女性，她到一家区综合医院急诊科就诊，突然出现眩晕、恶心和呕吐，但无局灶性神经功能缺损。在初始评估时，她感到明显头晕，睁眼时更严重。未增强的脑部计算机断层扫描（CT）以及CT血管造影均正常。初步诊断为偏头痛非典型表现或良性阵发性位置性眩晕。征求了卒中专科医生的意见，鉴于她症状持续，进行了脑部磁共振成像（MRI）检查。结果显示有三处小的急性梗死灶：一处位于左侧颞叶后部，一处位于左侧枕叶下部，一处位于左侧小脑蚓部。进一步的全面卒中检查无异常发现。她接受了双重抗血小板治疗和他汀类药物治疗。该病例突出了后循环缺血性卒中的诊断挑战，以及在不明原因眩晕患者中考虑该病的重要性，特别是那些有卒中危险因素的患者（该患者有先兆偏头痛、胆固醇升高和卒中家族史），以防止误诊和严重并发症。
