Peculiarities of central acute vestibular syndrome in patients admitted to the neurological department with suspected stroke

Abstract

Introduction. Analysis of the semiotics and etiological structure of central acute vestibular syndrome (c-AVS) in patients admitted to the neurological department with suspected stroke is important for the development of differential diagnostic algorithms for the timely identification of candidates for reperfusion therapy and early secondary prevention.The aim of the study was to study the clinical characteristics and determine the etiological structure of the c-AVS in patients admitted to the neurological department with suspected stroke.Materials and methods We examined 59 patients who were urgently admitted to the neurological department with suspected stroke. A detailed assessment of the otoneurological status (NIHSS and eNIHSS scales, STANDING and HINTS+ algorithms), search for the cause of stroke, and neuroimaging (DWI MRI) were performed.Results Thirty-four out of 59 patients had c-AVS. Spontaneous nystagmus was observed in 70 % of patients, blast-induced nystagmus in 94 %, unilateral positive impulse test of head rotation in 18 %, acute hearing loss in 21 %, and unexpressed cerebellar dysfunction in 56 %. One third of patients had visualized foci of cerebral lesions – infarcts in cerebellar artery basins (n = 9) and 2 cerebellar hemorrhages. Possible vestibular migraine was diagnosed in seven patients of this subgroup. Two patients were eventually diagnosed with possible Meniere's disease. The etiology of ts-OVS remained unknown in 12 patients.Discussion This study showed that the principle judgment on the nature of AVS according to STANDING and HINTS+ algorithms did not differ at the primary and repeated examinations, which confirms the effectiveness of using these diagnostic tools in emergency conditions.Conclusion One in three patients with c-AVS admitted to a neurological department with suspected stroke is identified by neuroimaging; a quarter of patients are eventually diagnosed with possible vestibular migraine and Meniere's disease; in the remaining patients the etiology of dizziness remains unknown.