Isolated Vascular Vertigo / 대한뇌졸중학회지

Strokes in the distribution of the posterior circulation may present with vertigo, imbalance, and nystagmus. Although the vertigo due to a posterior circulation stroke is usually associated with other neurologic symptoms or signs, small infarcts involving the cerebellum or brainstem can develop vertigo without other localizing symptoms. Approximately 11% of the patients with an isolated cerebellar infarction present with isolated vertigo, nystagmus, and postural unsteadiness mimicking acute peripheral vestibular disorders. The head impulse test can differentiate acute isolated vertigo associated with cerebellar strokes (particularly within the territory of the posterior inferior cerebellar artery) from more benign disorders involving the inner ear. Acute audiovestibular loss may herald impending infarction in the territory of anterior inferior cerebellar artery. Appropriate bedside evaluation is superior to MRIs for detecting central vascular vertigo syndromes. This article reviews the keys to diagnosis of acute isolated vertigo syndrome due to posterior circulation strokes involving the brainstem and cerebellum.

Clinical Characteristics of Ischemic Stroke Presenting as Isolated Dizziness in the Emergency Room

PURPOSE: This study aimed to survey the frequency of ischemic stroke mimicking peripheral vertigo (Pseudo-peripheral vertigo), the pattern of clinical presentation and the factors related to it. METHODS: The medical records of 641 patients who were diagnosed with ischemic stroke by brain magnetic resonance imaging (MRI) at the emergency department (ED) between January 2006 and December 2008 were retrospectively reviewed. RESULTS: Approximately 9.5% of patients suffering ischemic stroke presented at the ED with only the symptom of dizziness. The patients were predominantly male (74.2%), age >60 years (62.3%), and 91.2% of patients had multiple stroke risk factors. Cases of cerebral, cerebellar and brain stem infarction were 21.3%, 60.7% and 9.9%, respectively. No abnormal cerebellar function was reported in 44% of patients. All of the patients with typical peripheral vertigo symptoms had two or more stroke risk factors and tested as having normal cerebellar function. CONCLUSION: Of patients with stroke as diagnosed by brain MRI, 9.5% of them had only presented dizziness at the ED. Of the patients mimicking peripheral vertigo, 44% resulted with normal neurologic tests. Thus, evaluation by brain MRI should be considered for patients with stroke risk factors who receive a differential diagnosis of vertigo of central origin.

Clinical Characteristics of Ischemic Stroke Presenting as Isolated Dizziness in the Emergency Room

PURPOSE: This study aimed to survey the frequency of ischemic stroke mimicking peripheral vertigo (Pseudo-peripheral vertigo), the pattern of clinical presentation and the factors related to it. METHODS: The medical records of 641 patients who were diagnosed with ischemic stroke by brain magnetic resonance imaging (MRI) at the emergency department (ED) between January 2006 and December 2008 were retrospectively reviewed. RESULTS: Approximately 9.5% of patients suffering ischemic stroke presented at the ED with only the symptom of dizziness. The patients were predominantly male (74.2%), age >60 years (62.3%), and 91.2% of patients had multiple stroke risk factors. Cases of cerebral, cerebellar and brain stem infarction were 21.3%, 60.7% and 9.9%, respectively. No abnormal cerebellar function was reported in 44% of patients. All of the patients with typical peripheral vertigo symptoms had two or more stroke risk factors and tested as having normal cerebellar function. CONCLUSION: Of patients with stroke as diagnosed by brain MRI, 9.5% of them had only presented dizziness at the ED. Of the patients mimicking peripheral vertigo, 44% resulted with normal neurologic tests. Thus, evaluation by brain MRI should be considered for patients with stroke risk factors who receive a differential diagnosis of vertigo of central origin.

Clinical Analysis of Cerebellar Infarctions Diagnosed via the Emergency Department

PURPOSE: Diagnosis of a cerebellar infarct without signs such as weakness, ataxia, or focal neurologic findings is difficult. This study used a clinical review of cerebellar infarctions for the purpose of accurately diagnosing and properly managing such patients. METHODS: We retrospectively studied 94 cerebellar infarct patients who had been admitted to the university hospital via the emergency department from May 1995 to March 2001. We reviewed clinical records and radiologic findings and analyzed risk factors of cerebrovascular disease, chief complaints and associated symptoms, neurologic examinations, electrocardiograms, and brain CT and/or brain MRI findings. RESULTS: Fifty-four (57.4%) of the patients were men and forty (42.6%) were women, and their mean age was 64.1+/- 13.0 years. The most frequent risk factor was hypertension (55.3%), and others were diabetes mellitus (26.6%), cerebrovascular disease (17.0%), ischemic heart disease (10.6%), and atrial fibrillation (6.4%). As to the involved territory, 54 (57.4%) posterior inferior cerebellar artery infarcts, 15 (16.0%) superior cerebellar artery infarcts, 3 (3.2%) anterior inferior cerebellar artery infarcts, and 19 (20.2%) combined-territory infarcts were found. As for symptoms and signs, vertigo (69.1%) and nausea and/or vomiting (64.9%) were the most frequent: others were dysarthria (38.3%), headache (37.2%), ataxia (43.6%), motor weakness (38.3%), nystagmus (30.9%), and so on. Especially, seven (7.4%) patients showed isolated vertigo without paralysis, weakness, or ataxia. CONCLUSION: Vertigo, nausea, and vomiting were frequent clinical findings in 94 cerebellar infarct patients. Nine of these patients showed isolated vertigo. The posterior inferior cerebellar artery was the most frequently involved territory.

Vertebrobasilar Pathology of Acute Isolated Vertigo: A Case-Control Study

BACKGROUND : Till now, several studies advocated the vascular etiology as a cause of acute isolated vertigo without relevant lesions on magnetic resonance imaging (MRI). However, most of them were case series and ,even in a few case-control studies, inclusion criteria were obscure and vascular risk factors were not considered. OBJECTIVES: To investigate the clinical significance of vertebrobasilar artery (VBA) pathology in acute isolated vertigo without relevant lesions on MRI. Methods : 84 patients (26 male, 59 female; 62.5+/-0.2 years) with acute isolated vertigo who had no lesions on MRI were gathered. Seventy nine controls (30 male, 49 female; 58.4+/-0.1 years) consisted of subjects with clinically definite BPPV, epilepsy, tension headache, or lacunar infarction. All the subjects underwent MRI and magnetic resonance angiography (MRA). The vascular pathology of VBA and anterior circulation were examined and graded by the findings of MRA. Focal stenosis more than 50%, non- or faint-visualization, or dolichoectasia of VBA were regarded as significant. Risk factors of atherosclerosis were investigated and the severity of small vessel disease on MRI were ranked. RESULTS : Significant vascular pathology of VBA was found more frequently in patients with acute isolated vertigo (32.1%) than in controls (16.5%) (p0.05). Multivariate analysis including all the possible variables investigated confirmed the significant correlation between VBA pathology and acute isolated vertigo in our subjects (p<0.05). CONCLUSION : This study demonstrates that there is a signficant correlation between VBA pathology and acute isolated vertigo without lesions on MRI. It can support the importance of VBA pathology as a a cause of acute isolated vertigo.