{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T05:40:07Z","timestamp":1758692407916,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,9,6]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:p>A man in his 70s had an episode of vertical visual tilt after blinking, as if the room tilted to the right, and of deviation of the body to the right when he walked, together with slight vertigo and nausea. He was initially suspected to have a transient ischaemic attack and was investigated with neuroradiology, telemetry and echocardiography.<\/jats:p>\n               <jats:p>Neurological examination showed horizontal saccadic eye movements and deviation to the right with the Unterberger\u2019s test. Brain MRI revealed a minor stroke in the right parieto-occipital junction and an older, smaller infarction in the right cerebellum. There was only slight intimal atherosclerosis, and no cardiac abnormality was found. The stroke was classified as an embolic stroke of undetermined source.<\/jats:p>\n               <jats:p>Distinguishing central from peripheral lesions when symptoms are transient and discrete is challenging. Emergent brain MRI in patients with subtle subjective visual vertical tilt and vertigo can identify acute parieto-insular ischaemia.<\/jats:p>","DOI":"10.1136\/bcr-2025-267857","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T05:00:19Z","timestamp":1758690019000},"page":"e267857","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Paroxysmal tilt illusion after blinking\u2014an unusual form of stroke manifesting with parietal vertigo"],"prefix":"10.1136","volume":"18","author":[{"given":"Cecilia","family":"Ronnevi","sequence":"first","affiliation":[{"name":"Department of Neurology, Karolinska University Hospital, Stockholm, Stockholm County, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7613-5169","authenticated-orcid":false,"given":"Tiago","family":"Moreira","sequence":"additional","affiliation":[{"name":"Department of Neurology, Karolinska University Hospital, Stockholm, Stockholm County, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"2025092322000924000_18.9.e267857.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1999.tb09193.x"},{"key":"2025092322000924000_18.9.e267857.2","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2019.00172","article-title":"Perception of Verticality and Vestibular Disorders of Balance and Falls","volume":"10","author":"Dieterich","year":"2019","journal-title":"Front Neurol"},{"key":"2025092322000924000_18.9.e267857.3","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00907.2017"},{"key":"2025092322000924000_18.9.e267857.4","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2021.740711","article-title":"Associations Between Injury of the Parieto-Insular Vestibular Cortex and Changes in Motor Function According to the Recovery Process: Use of Diffusion Tensor Imaging","volume":"12","author":"Park","year":"2021","journal-title":"Front Neurol"},{"key":"2025092322000924000_18.9.e267857.5","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000009349","article-title":"Central vestibular disorder due to ischemic injury on the parieto-insular vestibular cortex in patients with middle cerebral artery territory infarction: Observational study","volume":"96","author":"Yeo","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"2025092322000924000_18.9.e267857.6","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1093\/brain\/121.8.1479","article-title":"Horizontal or vertical optokinetic stimulation activates visual motion-sensitive, ocular motor and vestibular cortex areas with right hemispheric dominance. 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