Do monosymptomatic stroke patients with dizziness present a vestibular syndrome without nystagmus? An underestimated entity

Abstract

Background and purposeVestibular symptoms are common in emergency department (ED) patients and have various causes, including stroke. Accurate identification of stroke in patients with vestibular symptoms is crucial for timely management. We conducted a prospective cross‐sectional study from 2015 to 2019 to determine stroke prevalence and associated symptoms in ED patients with vestibular symptoms, aiming to improve diagnosis and outcomes.MethodsAs part of the DETECT project, we screened 1647 ED patients with acute vestibular symptoms. Following a retrospective analysis of 961 head and neck magnetic resonance imaging (MRI) scans, we included 122 confirmed stroke cases and assessed them for vestibular signs and symptoms.ResultsStroke prevalence in dizzy patients was 13% (122/961 MRI scans). Most patients (95%) presented with acute vestibular symptoms with or without nystagmus, whereas 5% had episodic vestibular syndrome (EVS). Nystagmus was present in 50% of stroke patients. Eighty percent had a purely posterior circulation stroke, and nystagmus was absent in 46% of these patients. Seven patients (6%) had lesions in both the anterior and posterior circulation. Vertigo was experienced by 52% regardless of territory.ConclusionsA stroke was identified in 13% of ED patients presenting with acute vestibular symptoms. In 5%, it was EVS. Most strokes were in the posterior circulation territory; vertigo occurred with similar frequency in anterior and posterior circulation stroke, and absence of nystagmus was common in both.

Acute truncal ataxia without nystagmus

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We read with interest the paper by Nikles et al [1], where they present a cohort of patients with stroke-related dizziness but no nystagmus. We were surprised, however, that no reference was made to our data, published in this same journal, on acute truncal ataxia in patients with acute vertigo without nystagmus [2], which may reflect

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“…Nikles et al [1] retrospectively analysed 961 head and neck magnetic resonance imaging scans and reviewed notes in the 122 confirmed stroke cases to identify vestibular symptoms and ocular motor signs. We explored the frequency of ataxia without concurrent nystagmus in a cross section of patients with acute vertigo who presented to the emergency department at two centres in Argentina (n = 71) and the UK (n = 24), of whom a total of 30 patients had stroke syndromes [2].…”