Case reports of isolated vertigo due to cerebrovascular problems, in reference to differential diagnosis with peripheral vertigo

Acute vertigo and dizziness are two of the most common symptoms that prompt patient visits to internal medicine practitioners and the emergency room. Most of these patients are diagnosed as having peripheral vertigo. However, central vertigo is identified in some cases that is sometimes life threatening and the diagnoses require careful attention. Although vertigo due to cerebrovascular disorders is usually associated with other neurologic symptoms or signs, small infarcts in the cerebellum or brainstem can present with vertigo without other localizing symptoms. Diagnosis of such isolated vertigo has been increasing with recent developments in clinical neuro-otology and neuroimaging. We recently encountered five patients with central vertigo who were referred to the otolaryngology department as having peripheral vertigo from an internal medicine department and an emergency room. We present on and discuss the clinical manifestations of nystagmus, localization of the lesion based on magnetic resonance imaging (MRI) findings of the brain, and risk factors (hypertension and diabetes, obesity, heart disorder) of these cases.