Isolated vertigo as a manifestation of vertebrobasilar ischemia

Gomez, C. R.; Cruz‐Flores, Salvador; Malkoff, Marc; Sauer, Curtis M.; Burch, Christina M.

doi:10.1212/wnl.47.1.94

Cited by 109 publications

(84 citation statements)

References 5 publications

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“…Of 29 patients with vertebrobasilar insufficiency, 21% have episodic vertigo for at least 4 weeks as the only presenting symptom. 19,20 Moreover, patients with anterior inferior cerebellar artery infarction, anterior vestibular artery infarction, or cerebellar infarction may present with symptoms or signs similar to Meniere disease, benign paroxysmal positional vertigo, and vestibular neuritis, respectively. 5,[21][22][23] To prevent misdiagnosis of stroke in vertigo patients, vertebrobasilar insufficiency or posterior circulation infarction should be recognized as possible causes of acute-onset isolated vertigo.…”

Section: Discussionmentioning

confidence: 99%

Risk of Stroke in Patients Hospitalized for Isolated Vertigo

Lee¹,

Su²,

Ho³

et al. 2011

Stroke

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Background and Purpose-Vertigo is a common presenting symptom in ambulatory care settings, and stroke is its leading and most challenging concern. This study aimed to determine the risk of stroke in vertigo patients in a 4-year follow-up after hospitalization for acute isolated vertigo. Methods-The study cohorts consisted of all patients hospitalized with a principal diagnosis of vertigo (nϭ3021), whereas patients hospitalized for an appendectomy in 2004 (nϭ3021) comprised the control group and surrogate for the general population. Cox proportional hazard model was performed as a means of comparing the 4-year stroke-free survival rate between the 2 cohorts after adjusting for possible confounding and risk factors. Among vertigo patients, there was further stratification for risk factors to identify the group at high risk for stroke. Results-Of the 243 stroke patients, 185 (6.1%) were from the study cohort and 58 (1.9%) were from the control group.Comparing the 2 groups, patients with vertigo symptoms had a 3.01-times (95% CI, 2.20 -4.11; PϽ0.001) higher risk for stroke after adjusting for patient characteristics, comorbidities, geographic region, urbanization level of residence, and socioeconomic status. Vertigo patients with Ն3 risk factors had a 5.51-fold higher risk for stroke (95% CI, 3.10 -9.79; PϽ0.001) than those without risk factors. Conclusions-Vertigo patients are at higher risk for stroke than the general population. They should have a comprehensive neurological examination, vascular risk factors survey, and regular follow-up for several years after hospital discharge after treatment of isolated vertigo. (Stroke. 2011;42:48-52.)

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Section: Discussionmentioning

confidence: 99%

Risk of Stroke in Patients Hospitalized for Isolated Vertigo

Lee¹,

Su²,

Ho³

et al. 2011

Stroke

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“…5 Although none of the studies included in our systematic review compared the timing of onset across disorders, two uncontrolled, retrospective case series identified in our critical review reported that dizziness was typically abrupt in onset among pa tients with a cerebrovascular cause of acute dizziness. 48,49 Prodromal dizziness None of the studies in our systematic review reported on prodromal dizziness. A critical review of other evidence on transient, isolated episodes of prodromal dizziness preceding a pres entation of acute vestibular syndrome suggested a prevalence of about 25% among patients with vestibular neuritis 50,51 and a similar prevalence among patients with vertebrobasilar stroke.…”

Section: Typementioning

confidence: 94%

“…Recurrent epi sodes were reported in two retrospective case series of patients with cerebrovascular dizziness. 48,49 In the larger series, 29% (12/42) of patients with vertebrobasilar stroke had prodromal, isolated epi sodes of dizziness for up to two years before the stroke. Note: CNS = central nervous system.…”

Section: Typementioning

confidence: 98%

“…A critical review of other evidence on transient, isolated episodes of prodromal dizziness preceding a pres entation of acute vestibular syndrome suggested a prevalence of about 25% among patients with vestibular neuritis 50,51 and a similar prevalence among patients with vertebrobasilar stroke. 26,48,49 As a harbinger of stroke, these epi sodes presumably represent transient ischemic attacks.…”

Section: Typementioning

confidence: 99%

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Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome

Tarnutzer

Berkowitz

Robinson

et al. 2011

CMAJ

357

385

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“…46 Nonetheless, it could be suspected in a patient in whom only some of the vertigo attacks are accompanied by other symptoms of brainstem dysfunction such as diplopia. [47][48][49] In the absence of any simultaneous brainstem symptoms, a short history, of days rather than months, of frequent brief vertigo attacks lasting minutes rather than hours several times a day, should raise the suspicion that the attacks are posterior circulation transient ischaemic attacks (TIAs). Hearing symptoms, tinnitus and deafness, if unilateral and occurring at the same time as the vertigo attacks, suggest an aural rather than a brainstem problem.…”

Section: Diagnoses That Are Likely To Be Wrong In a Patient With Vertigomentioning

confidence: 99%

Diagnosis and management of vertigo

Halmagyi

2005

Clinical Medicine

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-Vertigo is an illusion of rotation due to a disorder of the vestibular system, almost always peripheral. In the history it must be distinguished from pre-syncope, seizures and panic attacks. A single attack of acute, isolated spontaneous vertigo lasting a day or more is due either to vestibular neuritis or cerebellar infarction; distinguishing between the two requires mastery of the head impulse test. Recurrent vertigo is mostly due to benign paroxysmal positioning vertigo (BPPV), Menière's disease or migraine. With a good history, a positional test, an audiogram and a caloric test, it is usually possible to distinguish between these. BPPV is the single most common cause of recurrent vertigo and can usually be cured immediately with a particle repositioning manoeuvre. Posterior circulation ischaemia very rarely causes isolated vertigo attacks and when it does the attacks are brief and frequent and the history is short. KEY WORDS What vertigo is and is notVertigo is an illusion of rotation caused by asymmetry of neural activity between the left and right vestibular nuclei. This can be induced in anyone• by simply spinning them at constant speed for about 20 seconds and then suddenly stopping them• by heating or cooling one labyrinth, as happens in the caloric test• by otoconial particles (calcium-containing debris: literally 'earstones') moving along semicircular canal duct, as happens in benign paroxysmal positional vertigo (BPPV). It can also be produced by sudden unilateral destruction of a normal vestibular end-organ, nerve or nucleus or vestibulo-cerebellum, a structure that normally inhibits the ipsilateral vestibular nucleus. (Bilateral simultaneous vestibular destruction does not produce vertigo -in fact, a patient with bilateral vestibular loss will never again experience vertigo from unilateral or asymmetrical vestibular stimulation.)Vertigo is always temporary. Even after the vestibular nerve on one side has been surgically severed, the resulting vertigo (and nystagmus) will abate within a few days. This is not because the vestibular nerve has re-anastomosed but because profound neurochemical changes occuring in the brainstem during the process of vestibular compensation restore symmetrical vestibular nucleus activity. Vertigo is always made worse by head movement; thus patients who are 'dizzy all the time' and are happy to move around whilst dizzy do not have vertigo.Patients with aural vertigo should not lose consciousness but some patients cannot give confident and convincing answers to such simple questions as 'Did it feel as if you were losing balance or as if you were losing consciousness? Did you feel as if you were going to pass out or fall over?' Patients with vertigo might lose consciousness if they have been vomiting a lot, or if they incurred a head injury when they fell.Witness descriptions are not much help in identifying vertigo, but can be helpful in identifying other paroxysmal disorders such as seizure and syncope. Whereas panic attacks, especially with hyperventilation, co...

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Isolated vertigo as a manifestation of vertebrobasilar ischemia

Abstract: Isolated vertigo can be the only manifestation of vertebrobasilar ischemia. Its frequency may be underestimated in clinical practice. Noninvasive testing is helpful both for diagnosis and follow-up.

Cited by 109 publications

References 5 publications

Risk of Stroke in Patients Hospitalized for Isolated Vertigo

Risk of Stroke in Patients Hospitalized for Isolated Vertigo

Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome

Diagnosis and management of vertigo

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