Prevalence of acute dizziness and vertigo in cortical stroke

 The more important question to answer is: How do you train emergency room staff to not dismiss theses cases in young adults as drunkenness?

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Prevalence of acute dizziness and vertigo in cortical stroke

Yuk Man Chan, Yean Wong, Noorulain Khalid, Stephen Wastling, Andreas Flores-Martin, Lucy-Anne Frank, Nehzat Koohi N, Qadeer Arshad, Indran Davagnanam, Diego Kaski

First published: 11 June 2021

https://doi.org/10.1111/ene.14964

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ene.14964

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ABSTRACT

Background

In posterior circulation stroke, vertigo can be a presenting feature. However, whether isolated hemispheric strokes present with vertigo is less clear, despite a few single case-reports in the literature. Here we, a) explored the prevalence of vertigo/dizziness in acute stroke and, b) considered the cortical distribution of these lesions in relation to both the known vestibular cortex and evolution of these symptoms.

Methods

We conducted structured interviews in 173 consecutive unselected patients admitted to the hyperacute stroke unit at the University College London Hospitals. The interview was used to evaluate whether the patient was suffering from dizziness and/or vertigo before the onset of the stroke and at the time of the stroke (acute dizziness/vertigo), and the nature of these symptoms.

Results

112 patients had subcortical lesions and 53 patients had cortical infarcts, of which 21 patients reported acute dizziness. Out of these 21, five patients reported rotational vertigo. 17 of the total 53 patients had lesions in known vestibular cortical areas distributed within the insular and parietal opercular cortices.

Conclusions

The prevalence of vertigo in acute cortical strokes was 9%, with no single locus of lesion overlap. There is growing evidence supporting a lateralised vestibular cortex, with speculation that cortical strokes affecting the right hemisphere, are more likely to cause vestibular symptoms than left-hemispheric strokes. We observed a trend for this association, with the right hemisphere affected in four of five patients who reported spinning vertigo at the onset of the stroke.