Any patient presenting with an acute onset of dizziness described as a spinning sensation should be thoroughly assessed for cerebellar stroke, as these often present in such a manner, prior to assuming that the source is simple vertigo.
Cerebellar strokes, whether due to infarct or hemorrhage, typically present with ataxic gait, abnormal Rhomberg, dysmetria with finger-to-nose and heel-to-shin testing, and nystagmus.
In addition, the dizziness associated with cerebellar strokes should be less reproducible and extinguishable than that due to simple vertigo.
In terms of imaging, remember that CT scanning is not the preferred radiologic modality for evaluating the cerebellum and posterior aspects of the brain; the thickness of the posterior skull tends to create significant artifact and distortion. If suspicion warrants, MRI should therefore be pursued.
