小脳虫部小節微小梗塞3症例の検討

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  • Three cases of cerebellar nodulus infarction

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We here report the clinical features of three patients presenting with isolated cerebellar nodulus infarction. All suddenly developed nausea, vomiting and walking difficulty. Two experienced horizontal, to-and-fro vertigo. On admission, two could not walk. Motion exacerbated nausea and vomiting for three patients. None of them showed typical cerebellar signs, including dysarthria, dysmetria, or decomposition. Nystagmus was lacking in two. For all three patients, diffusion-weighted image of MRI revealed an isolated, small, high-intensity lesion in the cerebellar nodulus. Symptoms spontaneously resolved over a few days with no residual signs. It is now known that isolated vertigo, or “pseudovestibular syndrome”, without limb ataxia or dysarthria can occur following cerebellar infarction, especially those in the PICA region. A number of recent reports rate that the same syndrome can also be caused by infarction localized at the cerebellar nodulus. This suggests that the cerebellar nodulus must be involved with the vestibular system. Horizontal to-and-fro vertigo might be characteristic of nodular infarction. We believe MRI is necessary for every patient who presents with sudden-onset nausea, vomiting and walking difficulty, even without nystagmus, rotatory vertigo, or limb ataxia.

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