New Insights Into Vertigo Attack Frequency as a Predictor of Ischemic Stroke

Abstract

Background: Recurrent attacks of vertigo account for 2.6 million emergency department visits per year in the USA, of which more than 4% are attributable to ischemic infarction. However, few studies have investigated the frequency of attacks of vertigo before an ischemic stroke.Methods: We conducted this retrospective analysis and manually screened the medical records of 231 patients who experienced recurrent attacks of vertigo prior to an ischemic stroke. Patients were divided into four different groups based on the frequency of vertigo attacks as well as the region of ischemic infarction. Those with ≤2 attacks of vertigo preceding the ischemic stroke were defined as the low-frequency group. Those with ≥3 attacks were defined as the high-frequency group. Clinical parameters, including vascular risk factors, average National Institutes of Health Stroke Scale (NIHSS) score, and infarction volume, were compared between the groups.Results: On analysis, we found that patients with posterior infarction in the high-frequency group exhibited a higher prevalence of vertebral artery stenosis. However, the incidence of diabetes mellitus (DM) was higher in the low-frequency group. In addition, patients with posterior infarction in the low-frequency group were more active in seeking medical intervention after an attack of vertigo. Notably, the brain stem, especially the lateral medullary region, had a higher probability of being involved in posterior infarction in the high-frequency group. However, the cerebellum was more commonly involved in posterior infarction in the low-frequency group.Conclusions: Our findings indicate that the clinical parameters, including arterial stenosis, DM, and magnetic resonance imaging (MRI) findings, differed between the low- and high-frequency groups. We also found that patients in the low-frequency group were more willing to seek medical intervention after the attacks of vertigo. These findings could be valuable for clinicians to focus on specific examination of the patients according to the frequency of vertigo attacks.

Vertigo in Acute Stroke Is a Predictor of Brain Location but Is Not Related to Early Outcome: The Experience of Sagrat Cor Hospital of Barcelona Stroke Registry

“…These results agree with those of Elhfnawy et al [ 51 ] who, in their study, found that there were fewer patients with associated neurological deficits in the vertigo group. We must differentiate our work from the interesting study published by Qiu et al [ 71 ]. In their study, previous vertigo attacks were a risk factor or predictor of the presence of posterior acute ischemic stroke, whereas, in our study, vertigo and labyrinthine symptoms are clinical symptoms present at the onset of stroke in all patients analyzed.…”

Cerebral Blood Flow Velocity Modulation and Clinical Efficacy of Acupuncture for Posterior Circulation Infarction Vertigo: A Systematic Review and Meta-Analysis

“…Hence, the importance of accurately assessing ischemic stroke in the posterior circulation is highlighted, and the utility of symptoms is emphasized [ 4 ]. Vertigo is a common complaint in the clinic with a high risk of recurrence [ 5 , 6 ]. According to the epidemiological survey, vertigo is one of the most common symptoms of POCI, occurring in 47%–75% of posterior circulation stroke patients [ 7 , 8 ].…”

Clinical Features Differ Between Patients With Vertigo Attack Only and Weakness Attack Accompanying Vertigo Before Vertebrobasilar Stroke: A Retrospective Study

“…These accompanying neurological deficits were observed in 11% of patients with vertebrobasilar ischemic stroke ( 7 , 8 ). As stroke is the leading cause of severe disability, failure to recognize focal deficits prior to vertebrobasilar stroke may result in worse outcomes ( 9 , 10 ). Thus, highlighting the differences in patients with vertigo attacks only and vertigo accompanying weakness attacks is important for secondary stroke prevention.…”