Vertebrobasilar ischaemia presenting as recurrent isolated vertigo

Chronic recurrent isolated vertigo is an uncommon manifestation of vertebrobasilar ischaemia. We report a 43-year-old female with 12-month history of recurrent attacks of isolated vertigo who presented with acute pontine infarctions. Clinical examination and vestibular function testing showed bilateral vestibular hypofunction affecting the horizontal and posterior semicircular canals and right saccule. Diffusion-weighted magnetic resonance imaging (MRI) demonstrated acute bilateral pontine infarcts and significant vertebrobasilar stenoses. The findings of recurrent isolated vertigo and bilateral vestibular hypofunction should not prevent a search for vertebrobasilar ischaemia, particularly in the presence of vascular risk factors.