High-Grade Inferior Cerebellar Artery Stenosis and Vertigo

Mechanism and Clinical Significance

High-grade stenosis of the inferior cerebellar arteries can cause vertigo symptoms and represents a serious vascular emergency requiring urgent evaluation, according to the American Heart Association 1, 2
Vertigo is a recognized symptom of vertebrobasilar insufficiency, including stenosis of the inferior cerebellar arteries, with compromised vertebrobasilar perfusion leading to ischemia of the cerebellum, brainstem, and inner ear structures 1, 2
Vertebral artery atherosclerosis accounts for approximately 20% of posterior circulation strokes, and vertebrobasilar arterial stenosis is associated with multiple ischemic episodes and higher risk of early recurrent stroke, as reported by the American Heart Association 1, 2

Symptoms associated with vertebral artery and inferior cerebellar artery disease include dizziness, vertigo, diplopia, perioral numbness, blurred vision, tinnitus, ataxia, bilateral sensory deficits, and syncope, according to the American Heart Association 1, 2, 4

A patient with high-grade stenosis in the inferior cerebellar artery territory presenting with intermittent dizziness should be immediately referred to the emergency department for urgent evaluation due to the high risk of stroke, as recommended by the American College of Cardiology 3
Immediate initiation of antithrombotic therapy is warranted, and medical management includes antiplatelet therapy, statins, and aggressive risk factor modification, according to the American College of Cardiology 2, 3
Revascularization options (surgical or endovascular) should be considered based on severity and symptomatology, coordinated with neurology, neurosurgery, and interventional radiology, as recommended by the Society of NeuroInterventional Surgery 2, 3

Complete neurovascular assessment with detailed neurological examination focusing on speech, gait, coordination, eye movements, and truncal ataxia is essential, as recommended by the American Academy of Neurology 5
MRI head without IV contrast is recommended for detection of posterior fossa infarcts, according to the American College of Radiology 6, 7
CTA or contrast-enhanced MRA is recommended for vascular imaging, as these have higher sensitivity and specificity than ultrasonography for vertebral artery stenosis, as reported by the American Heart Association 1, 2

Delaying evaluation of intermittent dizziness in the setting of known high-grade vascular stenosis can lead to preventable strokes, as warned by the American College of Cardiology 3
Missing truncal ataxia during bedside examination in patients with cerebellar stroke is a critical pitfall, as highlighted by the American Academy of Neurology 5
Failing to recognize that dizziness may be the only presenting symptom of posterior circulation ischemia is a common mistake, as cautioned by the American College of Cardiology 3