Cerebellar tumor misdiagnosed as cerebral ischemia

65-year-old Mr. Li had dizziness and visual rotation without obvious cause 5 months ago. The symptoms worsened when he changed his body position, and improved after lying down to rest. He went to a local hospital for treatment. A head CT scan showed no abnormalities. A cervical spine X-ray showed cervical spondylosis. The symptoms worsened 2 days ago, accompanied by nausea and vomiting. The vomitus was gastric contents, non-projectile. He had no headache, diplopia, or limb movement disorder. He was diagnosed with vertebral basilar artery insufficiency.

However, after a period of treatment, Mr. Li's symptoms did not improve. Physical examination revealed: horizontal nystagmus in both eyes, normal limb muscle strength and muscle tension, negative finger-to-nose test and heel-knee-shin test, difficulty standing with eyes closed, unable to open or close eyes, and no pathological signs. Vascular dilation and symptomatic treatment did not improve the condition. X-ray chest film, abdominal B-ultrasound, and ECT bone scan showed no abnormalities. Finally, a cranial MRI examination revealed a tumor in Mr. Li's left cerebellum.

After the tumor was found, Mr. Li was transferred to the Department of Surgery for surgery. The postoperative pathology report showed that the cerebellum tissue had poorly differentiated carcinoma metastasis, and the tumor cell immunohistochemical markers were consistent with the expression of metastatic carcinoma. After the operation, Mr. Li experienced nausea and vomiting, which was particularly severe after eating. Three months later, Mr. Li died due to worsening of his condition.

Tips: Elderly patients with dizziness should consider vertebral basilar artery insufficiency while excluding dizziness caused by other diseases. Patients with recurrent attacks and symptoms that are difficult to relieve should undergo a cranial MRI to rule out brain tumors.