Isolated acute vertigo in the elderly; vestibular or vascular disease?

Norrving, Bo; Magnusson, Måns; Holtås, Stig

doi:10.1111/j.1600-0404.1995.tb05841.x

Cited by 136 publications

(70 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, 2 patients did present with acute cerebrovascular diseases in this manner, echoing the many examples in the literature of posterior fossa strokes presenting as positional vertigo without concomitant brainstem findings. [18][19][20] Hence, physicians should not automatically dismiss the possibility of a central neurologic process in patients with dizziness without associated neurologic symptoms. The strengths of this study include its large sample size; independent adjudication of final diagnoses by 2 neurologists, with a third resolving any disagreements; detailed analysis of patients' risk factors, associated symptoms, examination findings, and medical and neurologic evaluations; and the potential for improved outcome ascertainment given the around-the-clock availability of modern neuroimaging and neurologic consultation.…”

Section: Discussionmentioning

confidence: 99%

Rate and Predictors of Serious Neurologic Causes of Dizziness in the Emergency Department

Navi

Kamel

Shah

et al. 2012

Mayo Clinic Proceedings

113

View full text Add to dashboard Cite

Objective: To describe the rate and predictors of central nervous system (CNS) disease in emergency department (ED) patients with dizziness in the modern era of neuroimaging. Patients and Methods: We retrospectively reviewed the medical records of all adults presenting between January 1, 2007, and December 31, 2009, to an academic ED for a primary triage complaint of dizziness, vertigo, or imbalance. The final diagnosis for the cause of dizziness was independently assigned by 2 neurologists, with a third neurologist resolving any disagreements. The primary outcome was a composite of ischemic stroke, intracranial hemorrhage, transient ischemic attack, seizure, brain tumor, demyelinating disease, and CNS infection. Univariate and multivariate logistic regression were used to assess the association between clinical variables and serious CNS causes of dizziness. Results: Of 907 patients experiencing dizziness (mean age, 59 years; 58% women [nϭ529]), 49 (5%) had a serious neurologic diagnosis, including 37 cerebrovascular events. Dizziness was often caused by benign conditions, such as peripheral vertigo (294 patients [32%]) or orthostatic hypotension (121 patients [13%]). Age 60 years or older (odds ratio [OR], 5.7; 95% confidence interval [CI], 2.5-11.2), a chief complaint of imbalance (OR, 5.9; 95% CI, 2.3-15.2), and any focal examination abnormality (OR, 5.9; 95% CI, 3.1-11.2) were independently associated with serious neurologic diagnoses, whereas isolated dizziness symptoms were inversely associated (OR, 0.2; 95% CI, 0.0-0.7). Conclusion: Dizziness in the ED is generally benign, although a substantial fraction of patients harbor serious neurologic disease. Clinical suspicion should be heightened for patients with advanced age, imbalance, or focal deficits.

show abstract

Section: Discussionmentioning

confidence: 99%

Rate and Predictors of Serious Neurologic Causes of Dizziness in the Emergency Department

Navi

Kamel

Shah

et al. 2012

Mayo Clinic Proceedings

113

View full text Add to dashboard Cite

show abstract

“…In recent years, cerebrovascular disease as a cause of isolated vertigo or dizziness has gained increased attention. Norrving, Magnusson, and Hlotás (1995) described 24 patients with acute isolated vertigo, age 50–75 years, in whom cerebellar infarction was found to be the cause in 25%. A retrospective analysis reviewed 907 case of dizziness visited in emergency department (ED) and found 37 cases (4%) were vascular origin.…”

Section: Introductionmentioning

confidence: 99%

Clinical and laboratory factors related to acute isolated vertigo or dizziness and cerebral infarction

et al. 2018

View full text Add to dashboard Cite

ObjectiveTo clarify the relationship of clinical factors with isolated vertigo or dizziness of cerebrovascular origin.MethodsClinical data of patients admitted in East Hospital from Jan. 2015 to Apr. 2016, whose complaint were acute vertigo or dizziness were retrospectively collected. All patients arrived at the emergency department within 24 hr of symptom onset, had no acute ischemic lesion first CT and NIHSS score of 0. Patients were divided into cerebral infarction group and noncerebral infarction group according to subsequent cerebral imaging results and clinical and laboratory factors related to cerebral infarction were analyzed.Result51.6% of patients were female (n = 141). 46 patients (16.8%) were diagnosed with acute cerebral infarction. Baseline demographic data of the two groups was not significantly different. Univariate analysis found that history of smoking (p = 0.009), headache (p = 0.028), unsteadiness (p = 0.009), neuron specific enolase (p = 0.001), and vertebral artery abnormalities found on imaging (p = 0.009) were the significant difference between two groups. Increased neuron specific enolase (p = 0.005) and an abnormal vertebral artery (p = 0.044) were significant on multivariate analysis.Conclusions16.8% of acute isolated vertigo or dizziness presentations were diagnosed with acute cerebral infarction. Increased serum neuron specific enolase and vertebral artery abnormalities were the strongest indicators of acute cerebral infarction.

show abstract

“…In a prospective study performed by Norrving B et al, similar to the results in our study, one out of every 4 patients with isolated acute vertigo, clinical misdiagnosis led to overdiagnosis of caudal cerebellar infarction. 16 Our results suggest that, neurological examination and audiovestibular findings may not always be sufficient to differentiate the underlying pathology and MRI technique can provide important findings for the diagnosis. 17 Larger studies are needed to see if MRI also has a potential to present statistically significant differences in the detection of clinically important pathologies more accurately and earlier.…”

Section: Discussionmentioning

confidence: 94%

Value of Magnetic Resonance Imaging and Audiology in the Emergency Department in Differential Diagnosis of Peripheral and Central Vertigo

Özakın¹,

Çoşkun²,

Saraç³

et al. 2012

Turkiye Klinikleri J Med Sci

View full text Add to dashboard Cite

A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Vertigo is a common complaint in the emergency room. Vertigo can be central or peripheral in origin and it is important for an emergency physician to make a correct differential diagnosis. The purpose of our study was to emphasize the role of cranial magnetic resonance imaging (MRI) and audiological tests in differential diagnosis of patients who present with vertigo to the emergency room. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Fifty patients (31 female, 19 male, mean age 50.84 years) with vertigo who were admitted to the Hacettepe University Faculty of Medicine Emergency Room (ER) between 01.10.2004 and 31.01.2005 were included in the study. Physical and neurological examinations of all patients were performed by senior residents and all patients were evaluated by Ear Nose Throat specialists. Audiologic and vestibular tests and MRI with 3T (Tesla) magnetic field power were performed in all patients. R Re es su ul lt ts s: : Among 29 patients with normal neurological examination, only 3 (10.3%) had lesions on MRI. MRI scans revealed lesions suggesting central vertigo etiology in six (18.2%) patients out of 33 with abnormal audiological test suggesting peripheral vestibulopathy. C Co on nc cl lu us si io on n: : In conclusion, in our prospective study, urgent cranial MRI technique in patients presenting to the emergency room with vertigo may reveal significant findings regarding the differential diagnosis and concomitant pathologies. However, meticulous neurological examination can exclude central vertigo in the majority of the patients.

show abstract

Isolated acute vertigo in the elderly; vestibular or vascular disease?

Abstract: A caudal cerebellar infarction may easily be misdiagnosed clinically as a labyrinthine disorder, and was found to be the cause in one fourth of patients presenting with isolated acute vertigo.

Cited by 136 publications

References 21 publications

Rate and Predictors of Serious Neurologic Causes of Dizziness in the Emergency Department

Rate and Predictors of Serious Neurologic Causes of Dizziness in the Emergency Department

Clinical and laboratory factors related to acute isolated vertigo or dizziness and cerebral infarction

Value of Magnetic Resonance Imaging and Audiology in the Emergency Department in Differential Diagnosis of Peripheral and Central Vertigo

Contact Info

Product

Resources

About