7 Thus, the ABCD 2 score may predict cerebrovascular attacks in patients with transient vertigo. 7 Especially, 27% of the patients with a score of 6 or 7 suffered from cerebrovascular episodes. 7 The authors found that only 1.0% of dizzy patients with a score of 3 or less had a cerebrovascular event compared to 8.1% of the patients with a score of 4 or more. 5 Another study adopted the ABCD 2 score, 6 a clinical prediction tool to assess the risk of stroke after a transient ischemic attack, to predict cerebrovascular events in emergency department patients with dizziness. 5 Particularly, the vertigo patients with 3 or more risk factors have a 5.51-fold higher risk for stroke (95% CI, 3.10-9.79 P<0.001) than those without risk factors. 5 The authors also demonstrated that the patients hospitalized with isolated vertigo have a 3.01-times (95% CI, 2.20-4.11 P<0.001) higher risk for stroke than the general population during the 4-year follow-up. Keywords: Isolated vertigo Stroke Vascular cause Acute vestibular syndrome Cerebellum BrainstemĪ recent study found that the patients who visited the emergency department with dizziness/vertigo had 2-fold (95% CI, 1.35-2.96 P<0.001) higher risk of stroke or cardiovascular events than those without dizziness/vertigo during a follow-up of 3 years. This article reviews the keys to diagnosis of acute isolated vertigo syndrome due to posterior circulation strokes involving the brainstem and cerebellum. Appropriate bedside evaluation is superior to MRIs for detecting central vascular vertigo syndromes. Acute audiovestibular loss may herald impending infarction in the territory of anterior inferior cerebellar artery. The head impulse test can differentiate acute isolated vertigo associated with cerebellar strokes (particularly within the territory of the posterior inferior cerebellar artery) from more benign disorders involving the inner ear. Approximately 11% of the patients with an isolated cerebellar infarction present with isolated vertigo, nystagmus, and postural unsteadiness mimicking acute peripheral vestibular disorders. Although the vertigo due to a posterior circulation stroke is usually associated with other neurologic symptoms or signs, small infarcts involving the cerebellum or brainstem can develop vertigo without other localizing symptoms. Strokes in the distribution of the posterior circulation may present with vertigo, imbalance, and nystagmus.
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