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Isolated rotational vertigo due to internal capsular infarction.

Kang Min Park1, Kyong Jin Shin, Sam Yeol Ha

  • 1Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

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Sudden vertigo and nystagmus can rarely result from a supratentorial stroke. This case highlights an unusual cause: an infarction in the posterior limb of the left internal capsule, leading to these vestibular symptoms.

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Area of Science:

  • Neurology
  • Neuroscience
  • Ophthalmology

Background:

  • Isolated rotational vertigo is typically linked to inner ear or central nervous system (CNS) posterior fossa disorders.
  • Supratentorial strokes are infrequently associated with isolated vertigo.
  • Understanding stroke-related vertigo is crucial for accurate diagnosis and treatment.

Observation:

  • A 64-year-old male presented with acute vertigo and horizontal nystagmus.
  • Symptoms included a torsional component in gaze, gait instability, and rightward axial lateropulsion.
  • Clinical presentation suggested a posterior fossa or peripheral vestibular lesion.

Findings:

  • Magnetic resonance imaging (MRI) revealed an infarction in the posterior limb of the left internal capsule.
  • This supratentorial lesion was identified as the cause of the patient's vestibular symptoms.
  • Internal capsule infarction is an atypical etiology for isolated rotational vertigo.

Implications:

  • This case expands the spectrum of neurological deficits associated with internal capsule strokes.
  • It underscores the importance of considering supratentorial lesions in vertigo evaluation.
  • Accurate localization of brain lesions is critical for managing complex vestibular presentations.