an unusual presentation of vertigo is head titubation the key to diagnosis一个不寻常的眩晕是蹒跚诊断的关键.pdfVIP

Hindawi Publishing Corporation International Journal of Otolaryngology Volume 2009, Article ID 358019, 4 pages doi:10.1155/2009/358019 Case Report An Unusual Presentation of Vertigo: Is Head Titubation the Key to Diagnosis? O. Judd and M. Medcalf Department of Otolaryngology, Derriford Hospital, Plymouth PL6 8DH, UK Correspondence should be addressed to O. Judd, owenjudd@.uk Received 28 October 2008; Revised 20 December 2008; Accepted 14 January 2009 Recommended by Bill Yates Objective. Discuss complex interplay of pathophysiological effects of cerebellar space occupying lesions on the vestibular pathway. Discuss challenges of diagnosis and referral along with differential and final diagnosis of unusual presentation. Case Report. We describe the case of a patient with vertiginous symptoms complicated by neurological features, namely, head titubation and tremor. The patient also had signs of oscillopsia and possible impairment of the vestibulo-ocular reflex. The resulting symptom and sign complex made for a difficult diagnosis, as the interplay of the pathophysiology of these signs, were unusual. Conclusion. The discussion has revealed that the cerebellar lesions themselves may have simultaneously caused head tremor and an inability for the vestibulo-ocular reflex to compensate, resulting in vertigo. However, whether the vertigo was a result of an oscillopsia, nystagmus, or central cause, the referral route should initially be via a general physician to rule out such a life threatening cause as a tumour. Copyright © 2009 O. Judd and M. Medcalf. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. Introduction