Posterior Inferior Cerebellar Infarct in a Younger Adult Male with Vertigo and Ataxia

Vertigo is a common complaint in patients who present to the emergency department. It can be a manifestation originating from several different disease processes. Although most patients with vertigo, especially younger patients, will have a benign disorder, up to 3% of such patients will have a cerebellar infarct. Although ruling out these types of fatal diagnoses is essential for emergency medicine physicians, this task can be especially complicated. Classic signs of a cerebellar infarct include symptoms suggestive of central vertigo with focal neurologic deficits on physical exam. Up to 10% of patients with cerebellar infarctions, however, present to the emergency department with vertigo and no focal neurologic deficits. The following case report discusses a male in his late twenties with the chief complaint of vertigo. On initial exam, he had no focal neurologic deficits but did have other concerning symptoms including severe ataxia. Imaging subsequently revealed the patient to have sustained a cerebellar infarct. When differentiating benign forms of vertigo from cerebellar infarcts or other central causes, the clinician should take into account risk factors such as central symptoms including neurologic deficits and severe ataxia. Implementing this strategy may decrease morbidity and mortality associated with cerebellar infarctions.