| A 77 year old patient with transient episodes of some 24 to 48 hours duration of vertigo for 8 or 9 months. He was admitted for a new episode of vertigo, more intense and long enough in duration to force him to remain in bed and associated with nausea and vomiting. Neurological examination found nystagmus on upward and left lateral gaze and dysmetria of the right leg and arm. He was unable to maintain his stance with retropulsion to the right.
The clinical picture, lasting months, had been attributed to osteoarthritis of the cervical spine (Figure 1). Most probably it was a series of transient ischaemic attacks that finally terminated in a right cerebellar stroke in the territory of the right PICA (Posterior Inferior Cerebellar Artery).
The outcome was satisfactory with almost complete recovery. Cervical spine arthritis can occur as with other disorders in other contexts (hiatus hernia and anaemia; vomiting and cholelithiasis) in which one must be very cautious when attributing a cause-effect relationship since they can disguise more serious disorders and delay their diagnosis.
Answer the autotest 
Author:
Juan I Pérez Calvo
Servicio de Medicina Interna
Hospital Clínico Universitario
Translation: Kelly
Watt |
