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

ABSTRACT

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.