Acute vertigo in emergency neurology

Patients presenting with acute vertigo are often admitted to hospital with a provisional diagnosis of a stroke in the vertebrobasilar system (VBS). The causes of such cases of acute vertigo, as well as the diagnostic value of various otoneurological examination methods (according to the STANDING and HINTS+ algorithms), have been little studied in Russian neurological practice.

Objective: to examine and optimize standard practice in the management of patients with acute vertigo in the emergency neurology department.

Material and methods. A total of 37 patients with acute vertigo, who were admitted to hospital on an emergency basis with a provisional diagnosis of acute cerebrovascular accident were examined. Clinical otoneurological examinations were carried out using the STANDING and HINTS+ algorithms, along with neuroimaging (DWI MRI), and the dynamics of acute vertigo severity were assessed against a background of comprehensive therapy comprising a fixed combination of 20 mg cinnarizine and 40 mg dimenhydrinate.

Results. A stroke was confirmed in 6 (16.2%) patients at the VBS, benign paroxysmal positional vertigo (BPPV) in 19 (51.4%), vestibular neuronitis in 4 (10.8%), vestibular migraine in 5 (13.5%), and Meniere's disease in 3 (8.1%). The factors showing the greatest significance for the diagnosis of VBS stroke were skew deviation, gaze-induced nystagmus and marked cerebellar ataxia (p<0.001), whilst a positive unilateral head-turning impulse test, spontaneous horizontal-rotatory nystagmus, mild and moderate vestibular ataxia, positive positional tests, and unilateral hearing loss were statistically significantly more prevalent in patients with other vestibular disorders (p<0.001). Patients with stroke were significantly older and had higher systolic blood pressure. A significant reduction in the severity of acute vertigo was observed in all patient groups following comprehensive treatment, comprising a fixed-dose combination of 20 mg cinnarizine and 40 mg dimenhydrinate, as assessed at a follow-up examination 7 days later (p<0.001).

Conclusion. A stroke in the vestibular system has been identified as the cause of acute vestibular vertigo in a small proportion of patients. BPPV has been identified as the most common cause (more than half of all cases). The tests used in the STANDING and HINTS algorithms have been shown to have varying levels of diagnostic value.

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