Nystagmus-Based Approach to Vertebrobasilar Stroke Presenting as Vertigo without Initial Neurologic Signs
- 12 October 2013
- journal article
- Published by S. Karger AG in European Neurology
- Vol. 70 (5-6), 322-328
- https://doi.org/10.1159/000353285
Abstract
Background: We aimed to investigate the clinical courses and common nystagmus of isolated vertigo patients with vertebrobasilar stroke. Methods: The patients who presented with isolated acute spontaneous vertigo with spontaneous nystagmus (acute vestibular syndrome) at the Emergency Department were retrospectively analyzed. They were referred to the Otolaryngology Department due to the absence of neurologic signs or even of imaging abnormalities after the initial examination at the Emergency Department. Various clinical features, including presenting symptoms, delayed neurologic signs, the site of infarction, and videonystagmographic (VNG) findings were analyzed. Results: Of the 468 cases of acute vestibular syndrome, 23 (4.9%) cases of radiologically proven vertebrobasilar stroke were identified. Of the 23 patients, 17 (74%) showed aggravation of vertigo or delayed neurologic signs during the admission. In the analysis of VNG, 11 (48%) cases of direction-changing gaze-evoked nystagmus, 7 (30%) cases of fixation failure in the caloric test, 6 (27%) cases of periodic alternating nystagmus, and 4 (17%) cases of atypical head-shaking nystagmus were presented. Stroke occurred in the cerebellum (n = 18, 78%), medulla (n = 4, 17%), and pons (n = 1, 4%). Conclusion: In the early stage of vertebrobasilar stroke, an accurate diagnosis was difficult in the Emergency Department even though a radiologic study was performed, but various VNG abnormalities and delayed neurologic signs could help to diagnose whether the origin is central or not.Keywords
This publication has 23 references indexed in Scilit:
- Misdiagnosis of Acute Peripheral Vestibulopathy in Central Nervous Ischemic InfarctionOtology & Neurotology, 2011
- Risk of Stroke in Patients Hospitalized for Isolated VertigoStroke, 2011
- Central Paroxysmal Positional Vertigo: Isolated Dizziness Caused by Small Cerebellar HemorrhageStroke, 2007
- Head-shaking nystagmus in lateral medullary infarctionNeurology, 2007
- Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparisonThe Lancet, 2007
- Stroke Among Patients With Dizziness, Vertigo, and Imbalance in the Emergency DepartmentStroke, 2006
- Dizziness and vertigo: an epidemiological survey and patient management in the emergency roomNeurological Sciences, 2004
- Neurological Deterioration in Acute Ischemic StrokeStroke, 1999
- Delay in Neurological Attention and Stroke OutcomeStroke, 1995
- Cerebellar infarction. Clinical and anatomic observations in 66 cases.Stroke, 1993