Abstract
ObjectiveVertigo is a common presentation of vertebrobasilar stroke. Anecdotal reports have shown that vertigo occurs more often in multiple than in single brainstem or cerebellar infarctions. We examined the relation between the location and volume of infarction and vertigo in patients with vertebrobasilar stroke.MethodsConsecutive patients with vertebrobasilar stroke were prospectively recruited. The infarction location and volume were assessed in the diffusion‐weighted magnetic resonance imaging.ResultsFifty‐nine patients were included, 32 (54.2%) with vertigo and 27 (45.8%) without vertigo. The infarction volume did not correlate with National Institute of Health Stroke Scale (NIHSS) score on admission (Spearman ρ = .077, p = .56) but correlated with modified Rankin Scale (ρ = .37, p = .004) on discharge. In the vertigo group, the proportion of men was lower (53.1% vs. 77.8%, p = .049), fewer patients had focal neurological deficits (65.6% vs. 96.3%, p = .004), patients tended to present later (median [IQR] was 7.5 [4–46] vs. 4 [2–12] hours, p = .052), numerically fewer patients received intravenous thrombolysis (15.6% vs. 37%, p = .06), and the total infarction volume was larger (5.6 vs. 0.42 cm3, p = .008) than in nonvertigo group. In multivariate logistic regression, infarction location either in the cerebellum or in the dorsal brainstem (odds ratio [OR] 16.97, 95% CI 3.1–92.95, p = .001) and a total infarction volume of >0.48 cm3 (OR 4.4, 95% CI 1.05–18.58, p = .043) were related to vertigo. In another multivariate logistic regression, after adjusting for age, sex, intravenous thrombolysis, serum level of white blood cells, and atrial fibrillation, vertigo independently predicted a total infarction volume of >0.48 cm3 (OR 5.75, 95% CI 1.43–23.08, p = .01).ConclusionInfarction location in the cerebellum and/or dorsal brainstem is an independent predictor of vertigo. Furthermore, larger infarction volume in these structures is associated with vertigo. A considerable proportion of patients with vascular vertigo present without focal neurological deficits posing a diagnostic challenge. National Institute of Health Stroke Scale is not sensitive for vertebrobasilar stroke.
Highlights
Dizziness is a major public health problem and an independent predictor of increased mortality (Corrales & Bhattacharyya, 2016)
Infarction location either in the cerebellum or in the dorsal brainstem and a total infarction volume of >0.48 cm3 were related to vertigo
In another multivariate logistic regression, after adjusting for age, sex, intravenous thrombolysis, serum level of white blood cells, and atrial fibrillation, vertigo independently predicted a total infarction volume of >0.48 cm3
Summary
Dizziness is a major public health problem and an independent predictor of increased mortality (Corrales & Bhattacharyya, 2016). Stroke is the underlying etiology in 17%–25%, and 4% of patients presenting with acute onset isolated vertigo (Norrving, Magnusson, & Holtas, 1995; Zuo et al, 2018) and dizziness (Navi et al, 2012), respectively. Lesions affecting the following structures are related to the development of vascular vertigo: vestibular nuclei in the dorsolateral portion of the rostral medulla, nucleus prepositus hypoglossi in the dorsal brainstem, dorsal insular cortex as well as cerebellar tonsil, flocculus, nodulus, and inferior cerebellar peduncles (Kattah, Talkad, Wang, Hsieh, & Newman-Toker, 2009; Kerber, Brown, Lisabeth, Smith, & Morgenstern, 2006; Kim, Kim, & Kim, 2017; Neuhauser et al, 2008; Rieger et al, 2014; Saber Tehrani et al, 2014). We aimed to examine the relationship of infarction volume and location to vertigo in patients diagnosed with a vertebrobasilar stroke
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