A Prospective Analysis of Lesion-Symptom Relationships in Acute Vestibular and Ocular Motor Stroke

Zwergal, Andreas; Möhwald, Ken; López, Elvira Salazar; Hadzhikolev, Hristo; Brandt, Thomas; Jahn, Klaus; Dieterich, Marianne

doi:10.3389/fneur.2020.00822

Cited by 23 publications

(19 citation statements)

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“…Second, vertigo, imbalance itself as a disabling symptom may be less significant, as vestibular tone imbalance due to central lesions are known to resolve within 2–4 weeks as a compensatory process ( 43 ). The cerebellum takes role in this compensatory mechanism within weeks, unless the patients have lesions in specific regions within the cerebellar hemispheres which might hinder compensatory processes ( 44 , 45 ). However, care should be noted in interpretation of the current findings because previous studies have found non-lacunar mechanisms in half of stroke patients presenting with AVS ( 46 ), and heterogenous stroke etiologies are also seen in our study.…”

Section: Discussionmentioning

confidence: 99%

Significance of Vertigo, Imbalance, and Other Minor Symptoms in Hyperacute Treatment of Posterior Circulation Stroke

et al. 2022

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BackgroundThis study aimed to determine the clinical significance of acute vestibular syndrome (AVS)/acute imbalance syndrome (AIS) in posterior circulation stroke (PCS) and how it should be addressed in the thrombolysis code.MethodsOur institution has recently changed its thrombolysis code from one that is generous to AVS/AIS to one that is exclusive. The subjects in this study were patients with PCS who presented before this transition (May 2016 to April 2018, period 1) and those who presented after (January 2019 to December 2020, period 2) with an onset-to-door time of 4.5 h. Hyperacute stroke treatment was compared between the two periods. The clinical significance of AVS/AIS was evaluated by dichotomizing the patients' clinical severity to minor or major deficits, then evaluating the significance of AVS/AIS in each group. Presenting symptoms of decreased mental alertness, hemiparesis, aphasia (anarthria), or hemianopsia were considered major PCS symptoms, and patients who did not present with these symptoms were considered minor PCS.ResultsIn total, 114 patients presented in period 1 and 114 in period 2. Although the code activation rate was significantly lower in period 2 (72.8% vs. 59.7%), p = 0.04, there were no between-group differences in functional outcomes (mRS score at 3 months; 1 [0–3] vs. 0 [0–3], p = 0.18). In 77 patients with PCS and AVS/AIS, the difference in code activation rate was not significant according to changes in thrombolysis code. In minor PCS, AVS/AIS was associated with lower NIHSS scores, lower early neurological deterioration rates, and favorable outcomes. In major PCS, while AVS/AIS was not associated with outcomes, the majority of cases were prodromal AVS/AIS which simple vertigo and imbalance symptoms were followed by a major PCS symptom.ConclusionsThis study failed to show differences in outcome in patients with PCS according to how AVS/AIS is addressed in the stroke thrombolysis code. In patients with minor PCS, AVS/AIS was associated with a benign clinical course. Prompt identification of prodromal AVS/AIS is essential.

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Section: Discussionmentioning

confidence: 99%

Significance of Vertigo, Imbalance, and Other Minor Symptoms in Hyperacute Treatment of Posterior Circulation Stroke

et al. 2022

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“…Die häufigsten episodischen Schwindelsyndrome sind der gutartiger Lagerungsschwindel, der meist den posterioren Bogengang betrifft (3), der Morbus Menière, der morphologisch durch einen Endolymphhydrops gekennzeichnet ist (4), und die vestibuläre Migräne, bei der funktionelle pathologische Veränderungen in zerebellären und thalamischen vestibulären Netzwerken nachgewiesen wurden (5). Chronische Schwindelsyndrome betreffen entweder bilaterale vestibuläre Afferenzen (bilaterale Vestibulopathie) (6), kortikale sensorimotorische Netzwerke (funktioneller Schwindel) ( 7) oder (vestibulo-)zerebelläre Strukturen (8).…”

Section: Akute Schwindelsyndromeunclassified

“…Hingegen sind Fragen nach der Symptomqualität (Dreh-versus Schwankschwindel), Symptomdauer (Stunden bis Tage) und Symptomintensität (milde versus starke Schwindelbeschwerden) weniger hilfreich. Eine prospektive Erhebung der Schwindelqualität bei Patienten mit vestibulären und okulomotorischen Schlaganfällen zeigte, dass 43% der Patienten über Schwankschwindel, 40% über Drehschwindel und 17% über Doppelbilder klagten [8]. Vor allem bei Läsionen im Kleinhirn waren Dreh-oder Schwankschwindel als Leitsymptom fast gleich häufig.…”

Section: Akute Schwindelsyndromeunclassified

“…Vor allem bei Läsionen im Kleinhirn waren Dreh-oder Schwankschwindel als Leitsymptom fast gleich häufig. Auch die Dauer der Schwindelbeschwerden bei einem Hirnstamm-oder Kleinhirninfarkt variierte stark von weniger als 1 Tag (13%), 1-4 Tage (26%) bis mehr als 4 Tage (61%) [8]. Kurze Schwindelattacken können daher auch zentraler Ursache sein [9].…”

Section: Akute Schwindelsyndromeunclassified

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Aktuelles zu den häufigen Schwindelsyndromen: Diagnostik und Therapie

Zwergal

Dieterich

2021

Fortschr Neurol Psychiatr

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ZusammenfassungDie 8 häufigsten Schwindelsyndrome liegen über 70% aller Schwindelpräsentationen zugrunde. Bei den akuten (meist einzeitigen) Schwindelsyndromen sind die akute unilaterale Vestibulopathie und der vestibuläre Schlaganfall von besonderer Bedeutung, bei den episodischen Schwindelerkrankungen der gutartige Lagerungsschwindel, der Morbus Menière und die vestibuläre Migräne und bei chronischem Schwindel die bilaterale Vestibulopathie/Presbyvestibulopathie, der funktionelle Schwindel und der zerebelläre Schwindel. In der letzten Dekade wurden für die häufigsten Schwindelsyndrome international konsentierte diagnostische Kriterien und Krankheitsbezeichnungen erarbeitet, die einfach im klinischen Alltag angewendet werden können. Die diagnostischen Leitlinien beruhen überwiegend auf einer gezielten Anamnese (Beginn, Dauer, Verlauf, Trigger, Begleitsymptome), klinischen Untersuchung und wenigen apparativen Verfahren zur Diagnosesicherung (vor allem mittels Videookulographie und Audiometrie). Die Therapie der häufigen Schwindelsyndrome basiert in der Regel auf einer Kombination aus physikalischen Verfahren (Lagerungsmanöver, multimodales Gleichgewichtstraining) und pharmakologischen Prinzipien (u.a. Kortikosteroide, Antiepileptika, Antidepressiva, Kaliumkanalblockern, plastizitätsfördernde Medikamente). Allerdings fehlt meist eine hochwertige Evidenz aus prospektiven und kontrollierten Studien. In der klinischen Praxis lassen sich die häufigen Schwindelsyndrome oft effektiv behandeln, sodass eine Chronifizierung oder sekundäre Komorbidität (durch Immobilität, Stürze oder psychiatrische Erkrankungen wie Angst oder Depression) vermieden werden kann.

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“…It has been established that stroke accounts for 2-13.4% of patients presenting to the emergency department (ED) with dizziness (1)(2)(3)(4)(5). Stroke is the second leading cause of death globally and has a limited treatment time window (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

A Dynamic Nomogram to Predict the Risk of Stroke in Emergency Department Patients With Acute Dizziness

Cao

2022

Front. Neurol.

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ObjectiveTo develop a risk prediction tool for acute ischemic stroke (AIS) for patients presenting to the emergency department (ED) with acute dizziness/vertigo or imbalance.MethodA prospective, multicenter cohort study was designed, and adult patients presenting with dizziness/vertigo or imbalance within 14 days were consecutively enrolled from the EDs of 4 tertiary hospitals between August 10, 2020, and June 10, 2021. Stroke was diagnosed by CT or MRI performed within 14 days of symptom onset. Participants were followed-up for 30 days. The least absolute shrinkage and selection operator (LASSO) logistic regression analysis was conducted to extract predictive factors that best identified patients at high risk of stroke to establish a prediction model. Model discrimination and calibration were assessed and its prediction performance was compared with the age, blood pressure, clinical features, duration, and diabetes (ABCD2) score, nystagmus scheme, and finger to nose test.ResultsIn this study, 790 out of 2,360 patients were enrolled {median age, 60.0 years [interquartile range (IQR), 51–68 years]; 354 (44.8%) men}, with complete follow-up data available. AIS was identified in 80 patients. An online web service tool (https://neuroby.shinyapps.io/dynnomapp/) was developed for stroke risk prediction, including the variables of sex, trigger, isolated symptom, nausea, history of brief dizziness, high blood pressure, finger to nose test, and tandem gait test. The model exhibited excellent discrimination with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.889 (95% CI: 0.855–0.923), compared with the ABCD2 score, nystagmus scheme, and finger to nose test [0.712 (95% CI, 0.652–0.771), 0.602 (95% CI, 0.556–0.648), and 61.7 (95% CI, 0.568–0.666) respectively].ConclusionOur new prediction model exhibited good performance and could be useful for stroke identification in patients presenting with dizziness, vertigo, or imbalance. Further externally validation study is needed to increase the strength of our findings.

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A Prospective Analysis of Lesion-Symptom Relationships in Acute Vestibular and Ocular Motor Stroke

Cited by 23 publications

References 38 publications

Significance of Vertigo, Imbalance, and Other Minor Symptoms in Hyperacute Treatment of Posterior Circulation Stroke

Significance of Vertigo, Imbalance, and Other Minor Symptoms in Hyperacute Treatment of Posterior Circulation Stroke

Aktuelles zu den häufigen Schwindelsyndromen: Diagnostik und Therapie

A Dynamic Nomogram to Predict the Risk of Stroke in Emergency Department Patients With Acute Dizziness

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