2015
DOI: 10.1212/wnl.0000000000002141
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Stroke risk stratification in acute dizziness presentations

Abstract: Objective: To estimate the ability of bedside information to risk stratify stroke in acute dizziness presentations.Methods: Surveillance methods were used to identify patients with acute dizziness and nystagmus or imbalance, excluding those with benign paroxysmal positional vertigo, medical causes, or moderate to severe neurologic deficits. Stroke was defined as acute infarction or intracerebral hemorrhage on a clinical or research MRI performed within 14 days of dizziness onset. Bedside information comprised … Show more

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Cited by 99 publications
(128 citation statements)
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“…Although vascular risk factors and neurological deficits were adequate for risk stratification of ischemia among dizzy patients according to one retrospective study [15], there is an inherent risk of biased stroke ascertainment due to clinical decisions-making in such studies. This suggests that prospective MRI-based studies are better suited for estimating the stroke-risk among dizzy patients without obvious neurological clues [11, 12]. In a retrospective study of patients referred to an otolaryngology department, the authors found a 4.9% prevalence of radiologically verified vertebrobasilary strokes among patients with isolated AVS, which is higher than the 3.1% seen in this study, possibly due to a higher rate of MRI investigations in the former, and different inclusion criteria [16].…”
Section: Discussionmentioning
confidence: 99%
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“…Although vascular risk factors and neurological deficits were adequate for risk stratification of ischemia among dizzy patients according to one retrospective study [15], there is an inherent risk of biased stroke ascertainment due to clinical decisions-making in such studies. This suggests that prospective MRI-based studies are better suited for estimating the stroke-risk among dizzy patients without obvious neurological clues [11, 12]. In a retrospective study of patients referred to an otolaryngology department, the authors found a 4.9% prevalence of radiologically verified vertebrobasilary strokes among patients with isolated AVS, which is higher than the 3.1% seen in this study, possibly due to a higher rate of MRI investigations in the former, and different inclusion criteria [16].…”
Section: Discussionmentioning
confidence: 99%
“…Another study suggested that as many as 1 in 4 elderly patients with isolated vertigo with nystagmus lasting >48 h may be affected by cerebellar infarction [17]. Yet another prospective study using MRI to detect stroke among AVS patients without obvious neurological signs showed a stroke prevalence of 10.7%, which due to the superior study design may be the most accurate proportion [11]. …”
Section: Discussionmentioning
confidence: 99%
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“…This may explain why patients with AF presented earlier in our study. Screening tools such as ABCD 2 (age, blood pressure, clinical features, duration and diabetes), which use vascular risk factors, have been shown to predict likelihood of stroke in acute dizziness presentations although sensitivity is lower in posterior as compared to anterior circulation stroke [18,21] . We did not identify an association between vascular risk factors including AF and accuracy of CBI diagnosis although our sample size was relatively small.…”
Section: Discussionmentioning
confidence: 99%
“…Gait imbalance together with persistent vertigo of >3 days duration, spontaneous nystagmus and a negative Head Impulse Test have also been reported to be useful clinical indicators of CBI [24] . Future implementation of bedside oculomotor examination including HINTS 'plus' assessment, which is not routine practice at our institution, may improve diagnostic accuracy in ED and identify patients with a negative first MRI who may warrant repeat imaging [21][22][23] .…”
Section: Discussionmentioning
confidence: 99%