Acute rotatory vertigo caused by a small haemorrhage of the vestibular cortex

Posterior cortical atrophy or the “visual variant” of Alzheimer’s disease is a clinical syndrome with visual agnosia, some or all the components of Balint’s syndrome, transcortical sensory aphasia, and Gerstmann’s syndrome.1 Although pathologically heterogeneous, several necropsy studies on patients with posterior cortical atrophy have shown Alzheimer’s disease pathology.1 We report a patient who presented with the features of posterior cortical atrophy who later developed mild parkinsonism, visual hallucinations, and delusions. Neuropathological evaluation revealed combined Alzheimer’s disease and Lewy body disease. A right handed retired diesel mechanic, with 12 years of formal education, was referred for evaluation of an “unusual dementia.” His difficulties started at the age of 58 with the insidious onset of visuospatial dysfunction. Initially he was not able to fill out bank deposit slips or write numbers correctly. He had been an avid reader but had to re-read material in order to comprehend it, and unsuccessfully used a card to keep his eyes focused when reading. He was not able to locate the refrigerator door handle until he groped over the surface to find it. His wife revealed that when he was 61 he was having difficulties working as a mechanic. Also, he could not see other cars and obstacles while driving, and he stopped driving at the age of 63 after being involved in two motor vehicle …