Skip to main content
SpringerLink
Log in

Recent Advances in Cerebellar Ischemic Stroke Syndromes Causing Vertigo and Hearing Loss

  • Review
  • Published:
The Cerebellum Aims and scope Submit manuscript

Abstract

Cerebellar ischemic stroke is one of the common causes of vascular vertigo. It usually accompanies other neurological symptoms or signs, but a small infarct in the cerebellum can present with vertigo without other localizing symptoms. Approximately 11 % of the patients with isolated cerebellar infarction simulated acute peripheral vestibulopathy, and most patients had an infarct in the territory of the medial branch of the posterior inferior cerebellar artery (PICA). A head impulse test can differentiate acute isolated vertigo associated with PICA territory cerebellar infarction from more benign disorders involving the inner ear. Acute hearing loss (AHL) of a vascular cause is mostly associated with cerebellar infarction in the territory of the anterior inferior cerebellar artery (AICA), but PICA territory cerebellar infarction rarely causes AHL. To date, at least eight subgroups of AICA territory infarction have been identified according to the pattern of neurotological presentations, among which the most common pattern of audiovestibular dysfunction is the combined loss of auditory and vestibular functions. Sometimes acute isolated audiovestibular loss can be the initial symptom of impending posterior circulation ischemic stroke (particularly within the territory of the AICA). Audiovestibular loss from cerebellar infarction has a good long-term outcome than previously thought. Approximately half of patients with superior cerebellar artery territory (SCA) cerebellar infarction experienced true vertigo, suggesting that the vertigo and nystagmus in the SCA territory cerebellar infarctions are more common than previously thought. In this article, recent findings on clinical features of vertigo and hearing loss from cerebellar ischemic stroke syndrome are summarized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Savitz SI, Caplan LR. Vertebrobasilar disease. N Engl J Med. 2005;352:2618–26.

    Article  CAS  PubMed  Google Scholar 

  2. Macdonell RA, Kalnins RM, Donnan GA. Cerebellar infarction: natural history, prognosis, and pathology. Stroke. 1987;18:849–55.

    Article  CAS  PubMed  Google Scholar 

  3. Bogousslavsky J, Van Melle G, Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 1988;19:1083–92.

    Article  CAS  PubMed  Google Scholar 

  4. Lee H, Yi HA, Cho YW, Sohn CH, Whitman GT, Ying S, et al. Nodulus infarction mimicking acute peripheral vestibulopathy. Neurology. 2003;60:1700–2.

    Article  CAS  PubMed  Google Scholar 

  5. Lee H, Cho YW. A case of isolated nodulus infarction presenting as a vestibular neuritis. J Neurol Sci. 2004;221:117–9.

    Article  PubMed  Google Scholar 

  6. Chen W, Fang J, Dong YR, Di Y, Li W. Teaching NeuroImages: isolated vertigo and imbalance due to deep border zone cerebellar infarct. Neurology. 2011;77, e122.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Kim DU, Han MK, Kim JS. Isolated recurrent vertigo from stenotic posterior inferior cerebellar artery. Otol Neurotol. 2011;32:180–2.

    Article  PubMed  Google Scholar 

  8. Norrving B, Magnusson M, Holtas S. Isolated acute vertigo in the elderly; vestibular or vascular disease? Acta Neurol Scand. 1995;91:43–8.

    Article  CAS  PubMed  Google Scholar 

  9. Lee H, Sohn SI, Cho YW, Lee SR, Ahn BH, Park BR, et al. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology. 2006;67:1178–83.

    Article  CAS  PubMed  Google Scholar 

  10. Lee H. Neuro-otological aspects of cerebellar stroke syndrome. J Clin Neurol. 2009;5:65–73.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Choi KD, Lee H, Kim JS. Vertigo in brainstem and cerebellar strokes. Curr Opin Neurol. 2013;26:90–5.

    Article  PubMed  Google Scholar 

  12. Lee H. Isolated vascular vertigo. J Stroke. 2014;16:124–30.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lee H, Sohn SI, Jung DK, Cho YW, Lim JG, Yi SD, et al. Sudden deafness and anterior inferior cerebellar artery infarction. Stroke. 2002;33:2807–12.

    Article  PubMed  Google Scholar 

  14. Lee H. Recent advances in acute hearing loss due to posterior circulation ischemic stroke. J Neurol Sci. 2014;338:23–9.

    Article  PubMed  Google Scholar 

  15. Lee H, Baloh RW. Sudden deafness in vertebrobasilar ischemia: clinical features, vascular topographical patterns, and long-term outcome. J Neurol Sci. 2005;228:99–104.

    Article  PubMed  Google Scholar 

  16. Newman-Toker DE, Kattah JC, Alvernia JE, Wang DZ. Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis. Neurology. 2008;70:2378–85.

    Article  PubMed  Google Scholar 

  17. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40:3504–10.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Chen L, Lee W, Chambers BR, Dewey HM. Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit. J Neurol. 2011;258:855–61.

    Article  CAS  PubMed  Google Scholar 

  19. Newman-Toker DE, Kerber KA, Hsieh YH, Pula JH, Omron R, Saber Tehrani AS, et al. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med. 2013;20:986–96.

    Article  PubMed  Google Scholar 

  20. Saber Tehrani AS, Kattah JC, Mantokoudis G, Pula JH, Nair D, Blitz A, et al. Small strokes causing severe vertigo: frequency of false-negative MRIs and nonlacunar mechanisms. Neurology. 2014;83:169–73.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Cnyrim CD, Newman-Toker D, Karch C, Brandt T, Strupp M. Bedside differentiation of vestibular neuritis from central “vestibular pseudoneuritis”. J Neurol Neurosurg Psychiatry. 2008;79:458–60.

    Article  CAS  PubMed  Google Scholar 

  22. Kim HA, Lee H. Isolated vestibular nucleus infarction mimicking acute peripheral vestibulopathy. Stroke. 2010;41:1558–60.

    Article  PubMed  Google Scholar 

  23. Kirchner H, Kremmyda O, Hufner K, Stephan T, Zingler V, Brandt T, et al. Clinical, electrophysiological, and MRI findings in patients with cerebellar ataxia and a bilaterally pathological head-impulse test. Ann N Y Acad Sci. 2011;1233:127–38.

    Article  PubMed  Google Scholar 

  24. Kim HA, Lee H. Recent advances in central vestibular syndromes of a vascular cause. J Neurol Sci. 2012;321:17–22.

    Article  PubMed  Google Scholar 

  25. Park HK, Kim JS, Strupp M, Zee DS. Isolated floccular infarction: impaired vestibular responses to horizontal head impulse. J Neurol. 2013;260:1576–82.

    Article  PubMed  Google Scholar 

  26. Kim HJ, Lee SH, Park JH, Choi JY, Kim JS. Isolated vestibular nuclear infarction: report of two cases and review of the literature. J Neurol. 2014;261:121–9.

    Article  PubMed  Google Scholar 

  27. Kerber KA, Brown DL, Lisabeth LD, Smith MA, Morgenstern LB. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke. 2006;37:2484–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Huh YE, Kim JS. Patterns of spontaneous and head-shaking nystagmus in cerebellar infarction: imaging correlations. Brain. 2011;134:3662–71.

    Article  PubMed  Google Scholar 

  29. Baier B, Dieterich M. Incidence and anatomy of gaze-evoked nystagmus in patients with cerebellar lesions. Neurology. 2011;76:361–5.

    Article  PubMed  Google Scholar 

  30. Moon IS, Kim JS, Choi KD, Kim MJ, Oh SY, Lee H, et al. Isolated nodular infarction. Stroke. 2009;40:487–91.

    Article  PubMed  Google Scholar 

  31. Kim HA, Yi HA, Lee H. Apogeotropic central positional nystagmus as a sole sign of nodular infarction. Neurol Sci. 2012;33:1189–91.

    Article  PubMed  Google Scholar 

  32. Kim SH, Park SH, Kim HJ, Kim JS. Isolated central vestibular syndrome. Ann N Y Acad Sci. 2015;1343:80–9.

    Article  PubMed  Google Scholar 

  33. Lee SH, Park SH, Kim JS, Kim HJ, Yunusov F, Zee DS. Isolated unilateral infarction of the cerebellar tonsil: ocular motor findings. Ann Neurol. 2014;75:429–34.

    Article  PubMed  Google Scholar 

  34. Lee H, Kim JS, Chung EJ, Yi HA, Chung IS, Lee SR, et al. Infarction in the territory of anterior inferior cerebellar artery: spectrum of audiovestibular loss. Stroke. 2009;40:3745–51.

    Article  PubMed  Google Scholar 

  35. Amarenco P, Hauw JJ. Cerebellar infarction in the territory of the anterior and inferior cerebellar artery. Brain. 1990;113:139–55.

    Article  PubMed  Google Scholar 

  36. Ahn BH, Kim HA, Yi HA, Oh SY, Lee H. Abnormal cervical vestibular-evoked myogenic potential in anterior inferior cerebellar artery territory infarction: frequency, pattern, and a determinant. J Neurol Sci. 2011;307:114–9.

    Article  PubMed  Google Scholar 

  37. Lee H. Audiovestibular loss in anterior inferior cerebellar artery territory infarction: a window to early detection? J Neurol Sci. 2012;313:153–9.

    Article  PubMed  Google Scholar 

  38. Bodranghien F, Bastian A, Casali C, Hallett M, Louis ED, Manto M, et al. Consensus paper: revisiting the symptoms and signs of cerebellar syndrome. Cerebellum. doi 10.1007/s12311-015-0687-3

  39. Kim JS, Lee H. Vertigo due to posterior circulation stroke. Semin Neurol. 2013;33:179–84.

    Article  PubMed  Google Scholar 

  40. Huh YE, Koo JW, Lee H, Kim JS. Head-shaking aids in the diagnosis of acute audiovestibular loss due to anterior inferior cerebellar artery infarction. Audiol Neurootol. 2013;18:114–24.

    Article  PubMed  Google Scholar 

  41. Lee H, Yi HA, Chung IS, Lee SR. Long-term outcome of canal paresis of a vascular cause. J Neurol Neurosurg Psychiatry. 2011;82:105–9.

    Article  PubMed  Google Scholar 

  42. Amarenco P, Hauw JJ. Cerebellar infarction in the territory of the superior cerebellar artery: a clinicopathologic study of 33 cases. Neurology. 1990;40:1383–90.

    Article  CAS  PubMed  Google Scholar 

  43. Kase CS, White JL, Joslyn JN, Williams JP, Mohr JP. Cerebellar infarction in the superior cerebellar artery distribution. Neurology. 1985;35:705–11.

    Article  CAS  PubMed  Google Scholar 

  44. Lee H, Kim HA. Nystagmus in SCA territory cerebellar infarction: pattern and a possible mechanism. J Neurol Neurosurg Psychiatry. 2013;84:446–51.

    Article  PubMed  Google Scholar 

  45. Kim HA, Yi HA, Lee H. Failure of fixation suppression of spontaneous nystagmus in cerebellar infarction: frequency, pattern, and a possible structure. Cerebellum. doi 10.1007/s12311-015-0688-2.

  46. Mazzoni A. Internal auditory canal. Arterial relations at the porus acusticus. Ann Otol Rhinol Laryngol. 1969;78:797–814.

    Article  CAS  PubMed  Google Scholar 

  47. Kim HN, Kim YH, Park IY, Kim GR, Chung IH. Variability of the surgical anatomy of the neurovascular complex of the cerebellopontine angle. Ann Otol Rhinol Laryngol. 1990;99:288–96.

    Article  CAS  PubMed  Google Scholar 

  48. Kim JS, Lee H. Inner ear dysfunction due to vertebrobasilar ischemic stroke. Semin Neurol. 2009;29:534–40.

    Article  PubMed  Google Scholar 

  49. Matsushita K, Naritomi H, Kazui S, Watanabe Y, Okazaki H, Kuriyama Y, et al. Infarction in the anterior inferior cerebellar artery territory: magnetic resonance imaging and auditory brain stem responses. Cerebrovasc Dis. 1993;3:206–12.

    Article  Google Scholar 

  50. Oas JG, Baloh RW. Vertigo and the anterior inferior cerebellar artery syndrome. Neurology. 1992;42:2274–9.

    Article  CAS  PubMed  Google Scholar 

  51. Kim HA, Lee BC, Hong JH, Yeo CK, Yi HA, Lee H. Long-term prognosis for hearing recovery in stroke patients presenting vertigo and acute hearing loss. J Neurol Sci. 2014;339:176–82.

    Article  PubMed  Google Scholar 

  52. Sunderland S. The arterial relations of the internal auditory meatus. Brain. 1945;68:23–7.

    Article  Google Scholar 

  53. Lee H. Sudden deafness related to posterior circulation infarction in the territory of the nonanterior inferior cerebellar artery: frequency, origin, and vascular topographical pattern. Eur Neurol. 2008;59:302–6.

    Article  PubMed  Google Scholar 

  54. Simmons Z, Biller J, Adams HP, Dunn V, Jacoby CG. Cerebellar infarction: comparison of computed tomography and magnetic resonance imaging. Ann Neurol. 1986;19:291–3.

    Article  CAS  PubMed  Google Scholar 

  55. Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ. 2011;183:E571–592.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

Two authors contributed equally as co-first authors to this work.

Author Contribution

Dr. Lee conducted the design and conceptualization of the study, interpretation of the data, and drafting and revising of the manuscript.

Drs. Kim and Yi wrote the manuscript and analyzed and interpreted the data.

Author information

Authors and Affiliations

  1. Department of Neurology, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea

    Hyun-Ah Kim, Hyon-Ah Yi & Hyung Lee

  2. Brain Research Institute, School of Medicine, Keimyung University, Daegu, Republic of Korea

    Hyun-Ah Kim, Hyon-Ah Yi & Hyung Lee

Authors
  1. Hyun-Ah Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyon-Ah Yi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hyung Lee.

Ethics declarations

Conflict of Interest

The authors declare that they have no competing interests.

Dr. Lee serves on the editorial boards of Frontiers in Neuro-otology, Research in Vestibular Science and Current Medical Imaging Review, and received research support from DAWOONG PHARMACEUTICAL, Co. Ltd.

Drs. Kim and Yi report no disclosures.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, HA., Yi, HA. & Lee, H. Recent Advances in Cerebellar Ischemic Stroke Syndromes Causing Vertigo and Hearing Loss. Cerebellum 15, 781–788 (2016). https://doi.org/10.1007/s12311-015-0745-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12311-015-0745-x

Keywords

Search

Navigation