Presentation
Acute onset vertigo and significant nystagmus. No convincing ENT symptoms though the left ear feels a bit "full" [clear on exam]. Very mild left dysdiadochokinesia and past pointing. Otherwise full neuro / cerebellar exam normal. T2DM, Obese, Hypertension so high stroke risk. Need to exclude posterior infarct before treating as labyrinthitis.
Patient Data
5mm focus of avid diffusion restriction in the left inferolateral pons at the level of the floor of the 4th ventricle.
Extensive established small vessel ischemic change.
No hemosiderin deposition.
No cerebellopontine angle or intracannilicular mass.
Case Discussion
Small, but clinically symptomatic, acute infarct in the lateral pons, coming under the broader themes of posterior circulation and brainstem stroke.
This size and location of this infarct are really only going to be diagnosed on MRI.