Background: Giddiness is a common presenting complaint in emergency and outpatient settings. While often attributed to benign peripheral vestibular disorders, central causes—particularly posterior circulation strokes—may present with isolated vertigo and subtle neurological findings, leading to misdiagnosis and delayed treatment. Objective: To describe a series of patients presenting primarily with acute giddiness who were clinically diagnosed with central vertigo secondary to suspected posterior circulation involvement. Methods: We report four patients presenting with acute onset giddiness with or without vomiting, dysphagia, hiccups, or gait instability. Detailed neurological examinations, including cerebellar assessment, were performed. Clinical findings were analyzed to differentiate central from peripheral vertigo. Results: All four patients exhibited cerebellar signs such as dysdiadochokinesia, dysmetria, gait ataxia, or direction-changing nystagmus. Vascular risk factors including hypertension, diabetes mellitus, smoking, and chronic alcohol use were present in all cases. None demonstrated classic hemiparesis or overt cranial nerve palsy at presentation. Clinical features strongly suggested posterior circulation ischemia. Conclusion: Posterior circulation stroke may present solely with giddiness and minimal neurological deficits. Careful bedside cerebellar examination and high clinical suspicion are essential for early identification. Acute vertigo in patients with vascular risk factors should prompt evaluation for central causes to prevent potentially fatal complications.
*Dr. Marchwin Kingston, Dr. Arjunan, Dr. Blessy K. (Sun,) studied this question.