A Case Report of Medullary Infarction with Vertigo in a Young Adult

It is generally known that cerebral infarction commonly occurs in elderly people. Rarely, cerebral infarction may occur in young adults due to complications such as collagen disease, heart disease, and dissecting aneurysm. We recently encountered a 32-year-old man who had occasionally complained of occipital pain after drinking alcohol since April 1999. As he also experienced sudden onset of vertigo with occipital pain, he went to the Department of Otolaryngology, Takarazuka City Hospital on April 14, 1999. Left-ward horizontal-rotatory spontaneous nystagmus was presented as shown in vestibular dysfunction. There were not any cerebellar signs, but left trigeminal hypesthesia suggested a central nervous system disorder. Moreoever, we found disturbances of touch, temperature, and pain sensations on the right upper and lower extremities.MRI showed an infarction in the left lateral medulla oblongata. Vertebral angiography showed an aneurysm in the distal and proximal segments of the left posterior inferior cerebellar artery. These findings indicated that medullary infarction was caused by dissecting aneurysm of the vertebral artery.In the present case, it was suggested that the intima of the vertebral artery rapidly deteriorated due to the dehydration resulting from excessive alcohol intake, and that neurological examination should be performed even in juvenile vertiginous cases.