Risk of stroke is low after transient ischemic attack presentation with isolated dizziness

Abstract

Objective Stroke presenting as dizziness is a diagnostic challenge in frontline settings, given the multitude of benign conditions that present similarly. The risk of stroke after episodic dizziness is unknown, leading to divergent guidance on optimal workup and management. Prior TIA risk scores have shown a history of dizziness is a negative predictor of subsequent stroke. Our objective was to assess the subsequent stroke risk within 90 days following emergency department assessment (ED) for isolated dizziness diagnosed as TIA during the index visit. Methods We conducted prospective, multicenter cohort studies at 13 Canadian EDs over 11 years. We enrolled patients diagnosed with TIA and compared patients with isolated dizziness to those with other neurological deficits. Our primary outcome was subsequent stroke within 90 days. Secondary outcomes were subsequent stroke within 2, 7, and 30 days, respectively, as well as subsequent TIA within 90 days. Results Only 4/483 (0.8%) patients with isolated dizziness had a stroke within 90 days compared to 320/11024 (2.9%) of those with any focal neurological sign or symptom (RR 0.29, 95% CI 0.11-0.76). Over the first 90 days, the two groups differ significantly in their probability of stroke (p = 0.007). Subsequent TIA was also significantly less common in the isolated dizziness group (1.7% vs. 5.6%, p = 0.001) with a relative risk of 0.30 (95% CI 0.15-0.60). ConclusionThe risk of subsequent stroke following ED presentation for TIA is low when the presenting symptoms are isolated dizziness.

Characteristics and risk of stroke in emergency department patients with acute dizziness

“…Some studies suggest that among ED visits suspected to be due to a transient ischemic attack (TIA), patients presenting with transient dizziness or vertigo are less likely to experience a subsequent stroke than those presenting with other symptoms [ 10 , 11 ]. This led to the assumption that most patients with acute dizziness or vertigo carry no increased stroke risk and are thus discharged from the ED.…”