Transient Vestibular Symptoms Preceding Posterior Circulation Stroke: A Prospective Multicenter Study

Abstract

Background and Purpose: The recognition of clinical features of transient vestibular symptoms (TVSs) preceding posterior circulation stroke (PCOS) would be informative to discriminate dizziness/vertigo due to vertebrobasilar transient ischemic attack from the acute transient vestibular syndrome. We sought to determine the prevalence and characteristics of TVSs preceding PCOS. Methods: We performed a prospective multicenter observational study that had recruited 447 patients with PCOS from referral-based 4 university hospitals in Korea. We investigated the timing, pattern, frequency, duration, and accompanying neurological symptoms of TVSs during the 3 months preceding PCOS. Results: The prevalence of TVSs preceding PCOS was 12% (55/447) during the previous 3 months. The TVSs preceding PCOS occurred within 1 week (33%), between 1 week and 1 month (16%), or between 1 and 3 months (51%). The TVSs were mostly dizziness/vertigo with (36%) or without (60%) imbalance, while the remaining 4% had an isolated imbalance. The dizziness/vertigo was spinning in 38% and was aggravated during head position in 45%. The duration of TVSs was mostly a few seconds (55%) or minutes (38%). Approximately 72% of the patients with PCOS had TVSs 1 to 5 times, while 16% had >10 times. Accompanying neurological symptoms, including headache, tinnitus, limb weakness, sensory change, dysarthria, visual field defect, and diplopia, were reported in 11%. Conclusions: Preceding TVSs can occur in 12% of PCOS during the previous 3 months. Isolated dizziness/vertigo of unknown cause needs to be considered as a vertebrobasilar transient ischemic attack symptom, especially in patients with vascular risk factors. The characteristics of isolated vestibular symptom in vertebrobasilar transient ischemic attacks is highly variable and atypical compared with other transient ischemic symptoms.

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

“…Similarly, Halmagyi et al [5] stress that vertebro-basilar ischemia rarely causes spells of isolated dizziness. These authorities are partly at odds with studies that found a certain proportion (about 10-20%) of posterior circulation stroke patients do retrospectively endorse transient episodes of isolated dizziness prior to their stroke presentation [6,7]. Our own work has found that patients with a history of transient dizziness are less likely to experience a subsequent stroke than others, when both groups are seen in the ED for possible TIA [8,9].…”

Significance of Vertigo, Imbalance, and Other Minor Symptoms in Hyperacute Treatment of Posterior Circulation Stroke

“…To achieve this goal, careful description of vertigo characteristics in this prodromal group must be performed. A recent literature described that transient vestibular symptoms preceding PCS occurred in 12% during the 3 previous 3 months, which is usually vertigo with or without imbalance, with durations usually seconds to minutes ( 34 ). Similar studies should be further performed to identify the population of prodromal vertigo.…”

Vascular vertigo and dizziness: Diagnostic criteria

“…Patients with infarction in the territory of the AICA can also experience recurrent vertigo in combination with fluctuating hearing loss and/or tinnitus as the initial symptoms 1–10 days prior to an infarction [ 103 ]. Thus, to prevent future strokes, it is crucial to identify those patients presenting with vertiginous episodes as a symptom of a TIA [ 83, 173 ].…”