Cerebellar Infarction Presenting with Acute Vestibular Syndrome in Two U.S. Air Force Pilots

Area of Science:

• Neurology
• Aerospace Medicine

Background:

• Cerebellar infarction is an uncommon cause of acute vestibular symptoms, often overlooked in young, healthy individuals.
• This condition can present similarly to peripheral vestibular disorders, leading to diagnostic delays.

Observation:

• Two U.S. Air Force pilots experienced cerebellar infarction presenting with vertigo and other vestibular symptoms.
• One pilot's event occurred during flight, highlighting the potential for serious occupational risk.
• Diagnostic imaging revealed cerebellar infarction, with echocardiography identifying patent foramen ovale in both cases.

Findings:

• Both pilots, despite initial misdiagnosis or delayed diagnosis, made full neurological recoveries.
• Patent foramen ovale was identified in both cases, suggesting a potential embolic source for the infarction.
• Prompt localization and accurate diagnosis are critical for appropriate management of central vestibular syndromes.

Implications:

• Cerebellar infarction should be considered in the differential diagnosis of acute vestibular syndrome, even in young, healthy patients.
• Utilizing evidence-based bedside screening methods can aid in the rapid localization of central vestibular causes.
• Increased awareness and careful clinical evaluation are essential to reduce misdiagnosis and ensure timely, effective treatment.