Atypical Presentation of Ischemic Stroke in A 64-Year-Old Female Patient with Multisystem Comorbidities: A Case Report
Putu Nadira Widyakania1*, Ketut Widyastuti2
Abstract
Introduction: Cerebellar ischemic stroke is a rare subtype of acute stroke, accounting for approximately 3% of ischemic strokes, with an estimated 27,400 new cases annually. The initial clinical presentation often resembles peripheral vestibular disorders, such as vertigo, nausea, and vomiting, which may lead to delayed diagnosis and management. Case Presentation: Mrs. D, a 64-year-old Javanese woman, accompanied by her family to the emergency department with acute-onset vertigo since the morning of admission. She reported nausea, vomiting, left-sided weakness and paresthesia, and slurred speech. The patient had a history of type II diabetes mellitus, chronic kidney disease, congestive heart failure due to coronary artery disease, and hypertension. Neurological examination revealed dysarthria, hemiparesis flaccid, with muscle strength graded 3/5 in the upper extremity and 4/5 in the lower extremity. The HINTS examination (Head Impulse, Nystagmus, Test of Skew) indicated a central-type vestibular vertigo. A head CT scan demonstrated an ischemic infarct in the right cerebellar hemisphere. The patient was treated conservatively with antiplatelet therapy, strict glycemic control, and close fluid monitoring due to the risk of overhydration associated with cardiac and renal dysfunction. Discussion: Similarities with peripheral vertigo symptoms often cause cerebellar stroke misdiagnosis. Studies show 50% of cases involve nausea and vomiting, whereas 75% involve vertigo. Bedside tests, such as HINTS, are more sensitive than MRI in detecting acute cerebellar strokes. MRI is the imaging modality’s gold standard, though the CT scan is more commonly used initially. Conclusion: A Multidisciplinary approach is crucial for patients with multiple comorbidities to optimize outcomes and prevent complications.
Keywords
cerebellar stroke; ischemic stroke; central vertigo; comorbidities; multidisciplinary care
Cite This Article
Widyakania, P. N., Widyastuti, K. (2025). Atypical Presentation of Ischemic Stroke in A 64-Year-Old Female Patient with Multisystem Comorbidities: A Case Report. International Journal of Scientific Advances (IJSCIA), Volume 6| Issue 6: Nov – Dec 2025, Pages 1086-1088 URL: https://www.ijscia.com/wp-content/uploads/2025/11/Volume6-Issue6-Nov-Dec-No.977-1086-1088.pdf
Volume 6 | Issue 6: Nov – Dec 2025
