Readers’ Choice 2012: Acute vertigo–Could it be a stroke? Part I

This five-part series continues as follows: Part II   Part III   Part IV   Part V

This is the first of a five part series on how to differentiate stroke from inner ear disease in acute vertigo. The main symptoms of cerebellar stroke (CS) are dizziness, nausea, vomiting, gait instability (unsteadiness while walking) , and headaches. This presents some difficulty because these symptoms are most often associated with common benign disorders such as migraine or peripheral vestibular (inner ear) disease. Differentiation between these benign disorders and cerebellar stroke (CS) can be aided by quick and simple examination including evaluation of control of eye movements, presence and pattern of nystagmus ( an involuntary rhythmic eye movement), and examination of gait and coordination (more on that later).

Stroke and TIA (transient ischemic attack) account for approximately 3% of dizziness complaints in the Emergency Department. Cerebellar strokes (CS) are uncommon and account for only 3% of all strokes. When the complaint of dizziness is isolated (e.g. no additional neurological complaints) stroke and TIA are responsible for less than 1% of patients with dizziness (Kerber, et al., 2006). The average age of CS patients is 65 years, with two-thirds being male. Risk factors for CS are similar to those associated with other stroke, and include: “hypertension, diabetes, cigarette smoking, hyperlipidemia, atrial fibrillation, and history of stroke or transient ischemic attack” (Edlow, Newman-Toker, & Savitz, 2008). Consequences of CS include death and permanent disability (Savitz, Caplan, & Edlow, 2006).
Next week – How can I be sure my dizziness is not a stroke?

Edlow, J., Newman-Toker, D., & Savitz, S. (2008). Diagnosis and initial management of cerebellar infarction. Neurology, 7, 951-964
Kerber, K., Brown, D., Lisbeth, L., Smith, M., & Morgenstern, L. (2006). Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke, 2484-2487.
Savitz, S., Caplan, L., & Edlow, J. (2007). Pitfalls in the diagnosis of cerebellar infarction. Acad Emerg Med, 14(1), 63-68.