Case Report Repetitive Episodic Isolated Vertigo in a Patient with Cerebellar Infarction Miyu Usui, MD,* Takafumi Mashiko, MD, PhD,* Masuko Tsuda, MD,* Masayuki Suzuki, MD,* Kosuke Matsuzono, MD, PhD,* Tadashi Ozawa, MD,* Yonhee Kim, MD,* Haruo Shimazaki, MD, PhD,* Reiji Koide, MD, PhD,* Ryota Tanaka, MD, PhD,* , † and Shigeru Fujimoto, MD, PhD* Isolated vertigo is an important symptom of posterior circulation stroke. It has been reported that 11.3% of patients with isolated vertigo have a stroke and that most lesions are located in the cerebellum, particularly in the posterior inferior cerebellar artery. We report the case of a 63-year-old man with multiple atherosclerotic risk factors and atrial fibrillation who showed repeated episodes of isolated vertigo. His repeated vertigo was short-lasting and was often triggered by body position, mim- icking benign paroxysmal positional vertigo. Cranial computed tomography on the third hospital day showed left cerebellar infarction within the territory of the poste- rior inferior cerebellar artery. The vertigo was ameliorated on the fifth hospital day and warfarin was prescribed for secondary prevention. Clinicians should pay spe- cial attention to cases in which a patient presents isolated vertigo, even if it shows transient recurrence or is triggered by a positional change, especially in patients with multiple cerebrovascular risk factors. Key Words: Isolated vertigo—cerebellar infarction—positional vertigo—CPPV © 2019 Elsevier Inc. All rights reserved. Introduction Isolated vertigo is an important symptom of posterior circulation stroke; 1 however, it may be difficult to diag- nose stroke if the vertigo is transient, repeating, or trig- gered by the patient's position. We report a case of recurrent transient isolated vertigo, which was finally diagnosed as cerebellar infarction. Case Presentation A 63-year-old man developed repeated sudden-onset and clockwise rotary vertigo without any other vestibular symptoms, including deafness, ear fullness or tinnitus, in episodes lasting approximately 5 minutes each. Cerebro- vascular risk factors included diabetes mellitus, hyperten- sion, atrial fibrillation and atrioventricular block with pacemaker implantation. Upon examination, left-beating nystagmus was observed but the finger-to-nose test, heal- to-knee test and rapid alternating movement test did not reveal cerebellar dysfunction. However, the vertigo recurred during a gait test. Initial cranial computed tomog- raphy (CT) showed no evidence of stroke with equivocal cerebellar lesions (Fig 1A). Although he only presented ves- tibular symptoms, we started antithrombotic treatment based on his multiple risk factors including untreated atrial fibrillation. After admission, the same sudden-onset and short-lasting episodic vertigo recurred, often accompanied by horizontal left-beating nystagmus, but the frequency of episodic vertigo gradually diminished and was eliminated From the *Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan; and †Stroke Center, Jichi Medical University Hospital, Tochigi, Japan. Received January 2, 2019; revision received March 17, 2019; accepted March 31, 2019. Financial Disclosures: None. Address correspondence to Takafumi Mashiko, MD, PhD, Division of Neurology, Department of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi 329-0498, Japan. E-mail: r0748tm@jichi.ac.jp. 1052-3057/$ - see front matter © 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.03.051 Journal of Stroke and Cerebrovascular Diseases, Vol. &&, No. && (&&), 2019: &&À&& 1 ARTICLE IN PRESS