Recognizing Posterior Circulation Transient Ischemic Attacks Presenting as Episodic Isolated Dizziness

Abstract

Diagnosing patients presenting to the emergency department with self-limited episodes of isolated dizziness (the episodic vestibular syndrome, or EVS) requires a broad differential diagnosis that includes posterior circulation transient ischemic attack (pc-TIA). Because these patients are by definition, asymptomatic without new neurological findings on exam, the diagnosis, largely based on history and epidemiological context, can be challenging. We review literature that addresses the frequency of pc-TIA in this group of patients, compared to other potential causes of the EVS. We present ways of distinguishing pc-TIA from vestibular migraine, the most common cause of the EVS. We also present a diagnostic algorithm that may help clinicians to work their way through the differential diagnosis.