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Rotational vertigo associated with parietal cortical infarction

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Abstract

A 65-year-old woman experienced sudden positional vertigo with rightward, horizontal nystagmus that resolved within days. MRI revealed a left parietal lobe infarction involving the supramarginal gyrus. The patient experienced a transient recurrence of vertigo after 7 days but MRI failed to reveal the presence of any new lesions; furthermore, the patient's EEG was normal. We suggest that this patient's vertigo was due to her parietal cortical infarction.

Introduction

Rotational vertigo is most often associated with problems in the semicircular canals, vestibular nerve [1], and/or brainstem [2], although it has also been reported to occur in patients with cerebral cortical lesions caused by tumors [3], infarction [4], [5] or hemorrhage [6]. Several reports suggested that multiple cortical areas including the parietal cortex constitute the vestibular cortex [3], [7], [8], [9], [10], [11], [12], [13], [14], [15]. We herein describe a patient who experienced rotational vertigo that was associated with an embolic infarction in the parietal cortex.

Section snippets

Case report

A 65-year-old healthy woman suddenly experienced rotational vertigo soon after she rotated her neck slowly to the right side while sitting in her chair around midnight. Her vertigo was pronounced when she attempted to move her head in any direction, and was diminished by head fixation. She did not experience nausea, headache, neck pain, hearing disturbance, or tinnitus. She was admitted to our hospital that same day.

Upon admission, she was conscious and alert and did not exhibit aphasia,

Discussion

The patient described in this report experienced sudden onset of positional vertigo with horizontal nystagmus to the right side. MRI revealed a new infarct in the left parietal lobe that involved the supramarginal gyrus. Vestibular epilepsy was unlikely to have been the cause of our patient's symptoms since her EEG was normal. Thus, it was likely that her vertigo was caused by her parietal cortical infarction, although we did not fully examine her cochlear and vestibular functions.

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