Recurrent brief positional vertigo as the initial presentation of medial branch of the posterior inferior cerebellar artery territory cerebellar infarction: a case report.

BACKGROUND

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.

CASE PRESENTATION: A 63-year-old man with poorly controlled hypertension presented with recurrent brief vertigo triggered mainly by lying down, getting up, or turning over in bed. Initial neurological examination, positional tests, and cranial CT were unremarkable, and BPPV was considered but not confirmed. Persistent attacks followed by spontaneous horizontal nystagmus and mild left-sided dysmetria prompted MRI-DWI, which revealed acute infarction in the medial left cerebellar hemisphere and vermis. After antiplatelet and statin therapy, he remained symptom-free at 1-, 3-, and 6-month follow-up, with an mRS score of 0.

CONCLUSIONS

mPICA territory infarction may mimic BPPV as brief recurrent positional vertigo. In older patients with vascular risk factors, persistent or atypical positional vertigo warrants repeated neurological examination and early MRI-DWI.