Yong-Kun Ruan,1,2,* Wang-Kai He,1,* Qing-Qing Chen,1 Hua Hu3 

1Department of Neurology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, 519020, People’s Republic of China; 2Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, People’s Republic of China; 3Department of Neurology, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Qing-Qing Chen, Department of Neurology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, No. 208 of Yuehua Street, Xiangzhou District, Zhuhai, 519020, People’s Republic of China, Tel +86-7568308361, Email chen_qq6699@163.com Hua Hu, Department of Neurology, The First Hospital of Hunan University of Chinese Medicine, No. 95 of Shaoshan Middle Road, Yuhua District, Changsha, 410007, People’s Republic of China, Tel +86-73185600120, Email hh201201201@163.com

Abstract: Vertigo, including central and peripheral causes, is one of the common symptoms in patients who are admitted to neurological outpatient and emergency rooms. Despite the advancements in imaging techniques in recent years, central vertigo is difficult to identify and is often misdiagnosed in clinical practice. In this study, 4 patients were admitted to the hospital with complaints of dizziness or vertigo. Information about their symptoms, physical examinations and imaging were collected. Two patients were accurately diagnosed using diffusion-weighted imaging (DWI), a specific type of brain MRI. They received targeted treatments, which led to significant improvement, and were discharged nearly cured within a week. One patient with dorsolateral medullary infarction was misdiagnosed due to atypical symptoms, such as vertigo without the typical lateral medullary syndrome signs, and was discharged with a mild swallowing disorder after 2 weeks of treatment. One patient was diagnosed with both central and peripheral vertigo. It was observed that the symptoms of isolated vertigo caused by an acute lacunar infarction resolved more quickly than the accompanying physical symptoms. In summary, more attention should be paid to the diagnosis of isolated central vertigo, as early identification and intervention can improve a patient’s prognosis and reduce medical expenses.

Keywords: cerebral infarction, isolated central vertigo, case series, central vestibular disorders, physical examination, brain MRI