What This Means
This case report describes a 63-year-old man with high blood pressure who experienced repeated brief episodes of dizziness triggered by changes in head position, such as lying down, getting up, or rolling over in bed. Initially, doctors suspected a common inner ear condition called benign paroxysmal positional vertigo (BPPV), and early tests including a CT scan and neurological examination appeared normal. However, because the episodes kept recurring and the patient later developed additional symptoms — uncontrolled eye movements and difficulty with coordination on his left side — doctors performed an MRI scan, which revealed a small stroke in the cerebellum, the part of the brain responsible for balance and coordination.
This research suggests that a specific type of cerebellar stroke, affecting a region supplied by the medial branch of the posterior inferior cerebellar artery (mPICA), can closely mimic BPPV by causing brief, position-triggered dizziness. This is important because BPPV is a benign condition, while a stroke requires prompt medical treatment to prevent further events. The patient was treated with antiplatelet medication and a cholesterol-lowering drug (statin), and he had no further symptoms and full functional recovery over six months of follow-up.
The case highlights a diagnostic pitfall: standard early tests such as CT scans and routine neurological exams can miss small cerebellar strokes, potentially delaying treatment. This research suggests that in older patients with cardiovascular risk factors like high blood pressure who have persistent or unusual positional dizziness, doctors should consider repeating neurological examinations over time and obtaining an MRI with diffusion-weighted imaging (MRI-DWI), which is more sensitive for detecting early stroke, even if initial tests appear normal.