Isolated nodular infarction and vestibular neuritis

ABSTRACT

An isolated nodular infarction presenting as an isolated vertigo with unidirectional, gaze-fixed nystagmus has not been previously reported. We reported a patient with cerebellar infarction who presented with purely isolated vertigo, ipsilesional, spontaneous nystagmus, and contralesional axial lateropulsion without usual symptoms or signs of cerebellar dysfunction. An MRI of the brain showed a small infarct selectively involving the nodulus. A pure vestibular syndrome in our patient may be explained by an ipsilateral involvement of nodulo-vestibular inhibitory projection to vestibular nucleus. Clinicians should be aware of the possibility of a nodulus infarction in patients with an acute vestibular syndrome, even if the pattern of nystagmus and lateropulsion is typical of vestibular neuritis.