CEREBELLAR INFARCTION MIMICKING LABYRINTHITIS

Abstract

Diagnosis and management of patient presenting with acute vertigo in the emergency department is a challenge for a clinician particularly when there is an associated history of ear discharge. Peripheral causes such as Benign  Paraoxysmal Positional Vertigo, Menieres disease and  labyrinthitis account for majority of cases presenting with acute vertigo. Central causes of acute vertigo though rare, must be kept under consideration especially in patients with risk factors such as diabetes and hypertension. Posterior circulation stroke presents with vertigo, gait ataxia and  imbalance and can therefore simulate labyrinthine disorders. Persistent severe ataxia with gaze induced nystagmus is a reliable clinical predictor for diagnosing a central  pathology. We present a case where a patient presented to the emergency department with acute onset vertigo and ear discharge that was initially treated for inner ear labyrinthitis and subsequently diagnosed to be an evolving posterior  circulation stroke