Isolated vertiginous dysequilibrium due to bilateral caudal cerebellar infarction

We present a 74-year-old woman who developed a sudden onset of vertigo, vomiting, and axial retropulsion without limb ataxia. A clinical diagnosis of acute peripheral labyrinthine lesion was made initially. However, magnetic resonance imaging demonstrated a small infarct area involving the caudal part of the cerebellar vermis and medial cerebellar hemispheres on both sides. We emphasize that a cautious attitude should be taken in managing patients with isolated vestibular dysfunction, especially in aged person or those associated with stroke risk factor.