The disease that often comes to mind when dizziness occurs is 'benign paroxysmal positional vertigo'. However, if it feels like the world is spinning and your body leans to one side, you should suspect 'cerebellar infarction'. In the acute phase, CT scans may appear normal, making it easy to miss cerebellar infarction. What should we be cautious about and how should we respond?
Does cerebral infarction accompany paralysis symptoms?… "Not necessarily in the early stages"
When thinking of cerebral infarction, symptoms like paralysis or speech disorders come to mind. However, cerebral infarction occurring in the cerebellum at the back of the brain is a bit different. Initially, dizziness may occur without any paralysis symptoms. This is a decisive reason for misunderstanding cerebellar infarction as benign paroxysmal positional vertigo or vestibular neuritis.
The problem is that if cerebellar infarction is not treated in time, symptoms can suddenly worsen. The cerebellum integrates information from the ear (vestibular system), eyes, muscles, and joints to maintain the body's balance. Therefore, if there is a blood flow disturbance in the cerebellum, dizziness may be the only symptom at first.
The pattern of dizziness is slightly different from benign paroxysmal positional vertigo… Unstable walking
Dizziness due to cerebellar infarction is characterized by a feeling of leaning to one side or losing balance. Difficulty walking alone and leaning against walls is a typical representation. Additionally, when trying to grab objects, you may miss, and symptoms of fine motor control issues may appear.
However, even if you visit the emergency room due to dizziness, CT scans may appear normal in the acute phase. This is because cerebellar and brainstem infarctions are located deep in the occipital region, and the lesions may be small. Even if the CT is normal, if there are warning signs, an MRI scan is necessary. Especially if there is a history of heart disease such as hypertension, diabetes, hyperlipidemia, or arrhythmia, or if severe dizziness occurs for the first time after the age of 50, it should be closely monitored.
Dr. Yoon Seung-jae, a neurologist at Seran Hospital, emphasized, "If severe dizziness lasts for a short time, it is less likely to be a cerebral infarction, but if it is not severe yet lasts for a long time, the possibility of cerebral infarction is high," and added, "Dizziness lasting more than 30 minutes must be diagnosed at a hospital." He further explained, "Those with chronic diseases, heart diseases, or smokers belong to the high-risk group for cerebellar infarction, so even mild dizziness should not be taken lightly."
