Abstract
Background: Recurrent attacks of vertigo account for 2.6 million emergency department visits per year in the USA, of which more than 4% are attributable to ischemic infarction. However, few studies have investigated the frequency of attacks of vertigo before an ischemic stroke.Methods: We conducted this retrospective analysis and manually screened the medical records of 231 patients who experienced recurrent attacks of vertigo prior to an ischemic stroke. Patients were divided into four different groups based on the frequency of vertigo attacks as well as the region of ischemic infarction. Those with ≤2 attacks of vertigo preceding the ischemic stroke were defined as the low-frequency group. Those with ≥3 attacks were defined as the high-frequency group. Clinical parameters, including vascular risk factors, average National Institutes of Health Stroke Scale (NIHSS) score, and infarction volume, were compared between the groups.Results: On analysis, we found that patients with posterior infarction in the high-frequency group exhibited a higher prevalence of vertebral artery stenosis. However, the incidence of diabetes mellitus (DM) was higher in the low-frequency group. In addition, patients with posterior infarction in the low-frequency group were more active in seeking medical intervention after an attack of vertigo. Notably, the brain stem, especially the lateral medullary region, had a higher probability of being involved in posterior infarction in the high-frequency group. However, the cerebellum was more commonly involved in posterior infarction in the low-frequency group.Conclusions: Our findings indicate that the clinical parameters, including arterial stenosis, DM, and magnetic resonance imaging (MRI) findings, differed between the low- and high-frequency groups. We also found that patients in the low-frequency group were more willing to seek medical intervention after the attacks of vertigo. These findings could be valuable for clinicians to focus on specific examination of the patients according to the frequency of vertigo attacks.
Highlights
Stroke is currently the second leading cause of death worldwide [1, 2]
231 patients with a definite diagnosis of ischemic infarction and a history of a vertigo attack preceding the stroke were included in the final analysis
On comparing the vascular risk factors for posterior infarction between the low- and high-frequency groups, we found that cases in the high-frequency group had a higher prevalence of vertebral artery stenosis (9.1 vs. 23.6%, P < 0.01)
Summary
Stroke is currently the second leading cause of death worldwide [1, 2]. Prompt medical intervention can prevent a transient ischemic attack (TIA) from evolving into acute stroke [3, 4]. Most patients are asymptomatic with normal findings on neurologic examination after the vertigo attack [6,7,8,9], and the symptoms usually dissipate in a short time, even without treatment. Due to these reasons and the absence of sensitive diagnostic tools, it is difficult to distinguish potential ischemic stroke from “peripheral” disorders. We conducted a retrospective analysis and screened the medical records of 231 patients who experienced recurrent vertigo attacks prior to an ischemic stroke. Few studies have investigated the frequency of attacks of vertigo before an ischemic stroke
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