Cardiometabolic Risk-Driven Diagnosis of Cerebellar Infarction Presenting as Isolated Transient Vertigo: A Case-Based Review

Background and Clinical Significance: Vertigo is a common manifestation of posterior circulation ischaemia, and obesity, type 2 diabetes mellitus, hypertension, and dyslipidaemia are established cardiometabolic risk factors for the underlying atherosclerotic disease. Brief, isolated episodes may be diagnostically challenging because bedside findings can be normal after symptom resolution, despite clinically significant cerebrovascular disease. We present a case in which an adverse cardiometabolic risk profile—rather than the clinical presentation itself—prompted the vascular imaging that established the diagnosis, together with a targeted review of comparable reports; Case Presentation: We investigate the case of a 67-year-old man with type 2 diabetes mellitus, hypertension, dyslipidaemia, obesity, and known asymptomatic right internal carotid artery (ICA) stenosis presented after a single spontaneous episode of rotatory vertigo lasting five minutes, which resolved completely before assessment. Neurological and structured neuro-otological examinations were normal. Because of his cardiometabolic and vascular risk burden, further imaging was pursued: CT angiography demonstrated progression of the right ICA stenosis to 85%, chronic occlusion of the left vertebral artery, and mild stenosis of the right vertebral artery, and brain MRI subsequently confirmed a small acute ischaemic lesion in the left cerebellar hemisphere. Management combined carotid artery stenting with a personalised, multidisciplinary secondary prevention plan addressing his full cardiometabolic risk profile. At three months, he remained asymptomatic, with NIHSS and modified Rankin Scale scores of 0. A targeted, CABARET-guided literature review of six comparable case reports showed that our patient carried the most extensive cardiometabolic burden yet had the mildest and most transient presentation, in contrast to the recurrent or progressive symptoms typical of the comparator reports; Conclusions: A single brief episode of isolated vertigo may be the only manifestation of acute posterior circulation ischaemia, even when bedside findings are normal. In patients with an adverse cardiometabolic and vascular risk profile, a reassuring examination should not preclude further neurovascular investigation, and early, risk-guided recognition—supported by personalised, multidisciplinary care—may provide an important opportunity for stroke prevention.