Ronnevi Cecilia, Moreira Tiago
Department of Neurology, Karolinska University Hospital, Stockholm, Stockholm County, Sweden.
Department of Neurology, Karolinska University Hospital, Stockholm, Stockholm County, Sweden
BMJ Case Rep. 2025 Sep 23;18(9):e267857. doi: 10.1136/bcr-2025-267857.
A man in his 70s had an episode of vertical visual tilt after blinking, as if the room tilted to the right, and of deviation of the body to the right when he walked, together with slight vertigo and nausea. He was initially suspected to have a transient ischaemic attack and was investigated with neuroradiology, telemetry and echocardiography.Neurological examination showed horizontal saccadic eye movements and deviation to the right with the Unterberger's test. Brain MRI revealed a minor stroke in the right parieto-occipital junction and an older, smaller infarction in the right cerebellum. There was only slight intimal atherosclerosis, and no cardiac abnormality was found. The stroke was classified as an embolic stroke of undetermined source.Distinguishing central from peripheral lesions when symptoms are transient and discrete is challenging. Emergent brain MRI in patients with subtle subjective visual vertical tilt and vertigo can identify acute parieto-insular ischaemia.
一名70多岁的男性在眨眼后出现垂直视觉倾斜发作，仿佛房间向右倾斜，行走时身体向右偏斜，同时伴有轻微眩晕和恶心。他最初被怀疑患有短暂性脑缺血发作，并接受了神经放射学、遥测和超声心动图检查。神经学检查显示水平扫视眼动以及昂特贝格尔试验时向右偏斜。脑部磁共振成像显示右顶枕交界处有轻微中风，右小脑有一个陈旧性、较小的梗死灶。仅存在轻微的内膜动脉粥样硬化，未发现心脏异常。该中风被归类为不明来源的栓塞性中风。当症状短暂且不连续时，区分中枢性病变和周围性病变具有挑战性。对于有轻微主观视觉垂直倾斜和眩晕的患者，紧急脑部磁共振成像可识别急性顶岛叶缺血。
