Dizziness in stroke
Abstract
Differential diagnosis of new-onset acute vestibular vertigo is chiefly made between vestibular neuronitis and stroke. Dizziness in stroke is usually accompanied by other focal neurological symptoms of brainstem and cerebellar involvement. However, stroke may appear as isolated vestibular vertigo in some cases. An analysis of history data and the results of neurovestibular examination and brain magnetic resonance imaging allows stroke to be diagnosed in patients with acute isolated dizziness. The treatment of patients with stroke-induced dizziness involves a wide range of medications for the reduction of the degree of dizziness and unsteadiness and for the secondary prevention of stroke. Vestibular rehabilitation is an important component of treatment. The paper describes an observation of a patient with poorly controlled hypertension, who developed new-onset acute systemic dizziness. Vestibular neuronitis might be presumed to be a peripheral cause of vestibular disorders, by taking into account the absence of additional obvious neurological symptoms (such as pareses, defective sensation, diplopia, etc.) and the nature of nystagmus. However, intention tremor in fingernose and heel-knee tests on the left side, a negative Halmagyi test, and results of Romberg’s test could suggest that stroke was a cause of
dizziness.
About the Author
M. V. Zamergrad
A.Ya. Kozhevnikov Clinic of Nervous System Diseases, Department of Nervous System Diseases and Neurosurgery, Faculty of Therapeutics, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia 11, Rossolimo St., Moscow 119021
Guta Clinic, Moscow, Russia 2, Fadeev St., Moscow 127006
Russian Federation
Russian Federation
References
1. Newman-Toker DE, Hsieh YH, Camargo CA Jr, et al. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc. 2008 Jul;83(7):765–75. doi: 10.4065/83.7.765.
2. Fetter M, Dichgans J. Vestibular neuritis spares the inferior division of the vestibular nerve. Brain. 1996 Jun;119(Pt 3):755–63.
3. Arbusow V, Schulz P, Strupp M, et al. Distribution of herpes simplex virus type I in human geniculate and vestibular ganglia: implications for vestibular neuritis. Ann Neurol. 1999 Sep;46(3):416–9.
4. Brandt T. Vertigo. Its Multisensory Syndromes. London: Springer; 2000. 503 p.
5. Huppert D, Strupp M, Theil D, et al. Low recurrence rate of vestibular neuritis: a longterm follow-up. Neurology. 2006 Nov 28;67(10):1870–1.
6. Kim YH, Kim KS, Kim KJ, et al. Recurrence of vertigo in patients with vestibular neuritis. Acta Otolaryngol. 2011 Nov;131(11):1172–7. doi: 10.3109/00016489.2011.593551. Epub 2011 Jul 5.
7. Savitz SI, Caplan LR. Vertebrobasilar disease. N Engl J Med. 2005 Jun 23;352(25):2618–26.
8. Исакова ЕВ, Романова МВ, Котов СВ. Дифференциальная диагностика симптома «головокружения» у больных с церебральным инсультом. Русский медицинский журнал. 2014;22(16):1200–5. [Isakova EV, Romanova MV, Kotov SV. Differential diagnosis of the symptom of «dizziness» in patients with cerebral stroke. Russkii meditsinskii zhurnal. 2014;22(16):1200–5. (In Russ.)].
9. Камчатнов ПР, Чугунов АВ, Михайлова НА. Вертебрально-базилярная недостаточность: механизмы развития и методы терапии. Фарматека. 2010;(7):27–31. Kamchatnov PR, Chugunov AV, Mikhailova NA. Vertebrobasilar insufficiency: mechanisms and therapies. Farmateka. 2010;(7):27–31. (In Russ.)].
10. Kerber KA, Brown DL, Lisabeth LD, et al. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke. 2006 Oct;37(10):2484–7. Epub 2006 Aug 31.
11. Grad A, Baloh RW. Vertigo of vascular origin. Clinical and electronystagmographic features in 84 cases. Arch Neurol. 1989 Mar;46(3):281–4.
12. Lee CC, Su YC, Ho HC, et al. Risk of stroke in patients hospitalized for isolated vertigo: a four-year follow-up study. Stroke. 2011 Jan;42(1):48–52. doi: 10.1161/STROKEAHA. 110.597070. Epub 2010 Dec 2.
13. von Brevern M, Sü βmilch S, Zeise D. Acute vertigo due to hemispheric stroke: a case eport and comprehensive review of the literature. J Neurol Sci. 2014 Apr 15;339(1–2):153–6. doi:10.1016/j.jns.2014.02.005. Epub 2014 Feb 14.
14. Kim AS, Fullerton HJ, Johnston SC. Risk of vascular events in emergency department patients discharged home with diagnosis of dizziness or vertigo. Ann Emerg Med. 2011 Jan;57(1):34–41. doi: 10.1016/j.annemergmed. 2010.06.559. Epub 2010 Sep 19.
15. Kattah JC, Talkad AV, Wang DZ, et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009 Nov;40(11):3504–10. doi: 10.1161/ STROKEAHA.109.551234. Epub 2009 Sep 17.
16. Newman-Toker DE, Kattah JC, Alvernia JE, Wang DZ. Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis. Neurology. 2008 Jun 10;70(24 Pt 2):2378–85. doi: 10.1212/01.wnl.0000314685.01433.0d.
17. Chalela JA, Kidwell CS, Nentwich LM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007 Jan 27;369(9558):293–8.
18. Oppenheim C, Stanescu R, Dormont D, et al. False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol. 2000 Sep;21(8):1434–40.
19. Аптикеева НВ, Долгов АМ. Вестибулярное головокружение и атаксия в неотложной неврологии. Неврология, нейропсихиатрия, психосоматика. 2013;5(4):34–8. [Aptikeeva NV, Dolgov AM. Vestibular vertigo and ataxia in emergency neurology. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;5(4):34–8. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2013-4.
20. Парфенов ВА, Хасанова ДР. Ишемический инсульт. Москва: МИА; 2012. 288 с. [Parfenov VA, Khasanova DR. Ishemicheskii insul't [Ischemic Stroke]. Moscow: MIA; 2012. 288 p.]
21. Суслина ЗА, Варакин ЮЯ, Верещагин НВ. Сосудистые заболевания головного мозга. Москва: МедПресс Информ; 2006. 255 с. [Suslina ZA, Varakin YuYa, Vereshchagin NV. Sosudistye zabolevaniya golovnogo mozga [Vascular diseases of the brain]. Moscow:
22. MedPress Inform; 2006. 255 p.]
23. Фейгин В, Виберс Д, Браун Р. Инсульт: Клиническое руководство. Москва: Бином; Санкт-Петербург: Диалект; 2005. 608 с. [Feigin V, Wiebers D, Brown R. Handbook of Stroke. Moscow: BINOM; Saint-Petersburg: Dialekt; 2005. 608 p.]
24. Strupp M, Thurtell MJ, Shaikh AG, et al. Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus. J Neurol. 2011 Jul;258(7):1207–22. doi: 10.1007/s00415- 011-5999-8. Epub 2011 Apr 2.
25. Thurtell MJ, Leigh RJ. Treatment of nystagmus. Curr Treat Options Neurol. 2012 Feb;14(1):60–72. doi: 10.1007/s11940-011- 0154-5.
26. Felisati G, Battaglia, A, Papini MG, et al. Nicergoline in balance alterations in adult and elderly patients: a double-blind, placebo-controlled study. Clin Drug Invest. 2002;22(11):731–40.
27. Balci BD, Akdal G, Yaka E, Angin S. Vestibular rehabilitation in acute central vestibulopathy: a randomized controlled trial. J Vestib Res. 2013;23(4–5):259–67. doi: 10.3233/VES-130491.
28. Brown KE, Whitney SL, Marchetti GF, et al. Physical therapy for central vestibular dysfunction. Arch Phys Med Rehabil. 2006 Jan;87(1):76–81.
For citation:
Zamergrad M.V. Dizziness in stroke. Neurology, Neuropsychiatry, Psychosomatics. 2015;7(2):47-51. (In Russ.) https://doi.org/10.14412/2074-2711-2015-2-47-51
Views: 2824
Email this article 