Incidence of acute cerebral infarction or space occupying lesion among patients with isolated dizziness and the role of D-dimer.

Sion Jo,Jaechol Yoon,Boyoung Park,Taeoh Jeong,Jae Baek Lee,Youngho Jin

doi:10.1371/journal.pone.0214661

Sion Jo, Jaechol Yoon + Show 4 more

Open Access

PDF Available

https://doi.org/10.1371/journal.pone.0214661

Copy DOI

Export

Save

Cite

Abstract
Highlights/Summary
Full-Text PDF
Similar Papers

Abstract

Listen

BackgroundTo determine the incidence of acute cerebral infarction or space occupying lesion (SOL) among patients with isolated vertigo or dizziness (IVD) and to evaluate the role of cerebellar function test (CFT) and D-dimer to discriminate ACI/SOL and non-ACI/SOL.MethodsA retrospective study of consecutive emergency department (ED) patients with IVD during one year was conducted. ACI was based on the diffusion-weighted magnetic resonance imaging (DW-MRI), and SOL was based on the concurrent MRI sequences. A sensitivity analysis of CFT and D-dimer was also performed.ResultsAmong the 468 patients enrolled, 13 patients (2.8%) had ACI, 11 at cerebellum, 1 at occipital lobe, and 1 at centrum semiovale. Twenty-five patients (5.3%) had SOL. Aneurysm is most frequent (n = 7), followed by meningioma (n = 4) and venous anomaly (n = 4). In total, ACI/SOL was found in 8.1% (n = 38). Abnormal findings in finger-to-nose (FN), heel-to-shin (HTS), and rapid alternative movement (RAM) tests were significantly higher in ACI or ACI/SOL group, while gait disturbance, tandem gait abnormality, and Romberg’s test were not. CFT sensitivities were low for ACI as well as for ACI/SOL, but specificities were high for ACI and ACI/SOL. D-dimer level showed a sensitivity of 100% at >0.18 mg/L for ACI and >0.15 mg/L for ACI/SOL. However, specificity was low at corresponding D-dimer level. Among the subgroup (n = 411) who did not show any abnormality in CFT, 9 patients (2.2%) had ACI, and 33 patients (8.0%) had ACI/SOL.ConclusionThe present study reports a clinically significant incidence of ACI/SOL among ED patients with IVD. D-dimer showed high sensitive and low specificity, while CFT showed low sensitivity and high specificity.

Highlights

In the United States alone, an estimated 7.5 million patients with dizziness are seen in ambulatory care setting [1]
Abnormal findings in finger-to-nose (FN), heel-to-shin (HTS), and rapid alternative movement (RAM) tests were significantly higher in acute cerebral infarction (ACI) or ACI/ space occupying lesion (SOL) group, while gait disturbance, tandem gait abnormality, and Romberg’s test were not
cerebellar function test (CFT) sensitivities were low for ACI as well as for ACI/SOL, but specificities were high for ACI and ACI/SOL

Summary

Introduction

In the United States alone, an estimated 7.5 million patients with dizziness are seen in ambulatory care setting [1]. Stroke is difficult to distinguish from other diseases if a patient presents symptoms of dizziness without any accompanying focal neurological deficits, which traditionally refers to isolated vertigo or dizziness (IVD). Diagnosis becomes even more challenging if features of stroke and peripheral-type dizziness are combined [4]. Such complexity often calls for scrupulous evaluation, including brain imaging, to confirm whether it is stroke or not. To determine the incidence of acute cerebral infarction or space occupying lesion (SOL) among patients with isolated vertigo or dizziness (IVD) and to evaluate the role of cerebellar function test (CFT) and D-dimer to discriminate ACI/SOL and non-ACI/SOL

Methods

Results

Conclusion