Diagnosing Stroke in Acute Dizziness and Vertigo

Tehrani, Ali S. Saber; Kattah, Jorge C.; Kerber, Kevin A.; Gold, Daniel R.; Zee, David S.; Urrutia, Victor C.; Newman‐Toker, David E.

doi:10.1161/strokeaha.117.016979

Cited by 130 publications

(146 citation statements)

References 75 publications

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“…Magnetic resonance imaging diffusion-weighted images may miss 15-20% of posterior fossa infarctions, especially in the first 48 hours of the onset of symptoms. 23,24 Some cases of strokes may be missed despite evaluation by stroke neurologists and the acquisition of MRI images.…”

Section: Disclosurementioning

confidence: 99%

Stroke mimics: Clinical characteristics and outcome

Khathaami

Alsaif

Bdah

et al. 2020

NSJ

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Stroke(‫الدماغية‬ ‫السكتة‬ ‫مشابهات‬ ‫انتشار‬ ‫مدى‬ ‫معرفة‬ ‫األهداف:‬ ‫الطوارئ‬ ‫قسم‬ ‫إلى‬ ‫احملولني‬ ‫السعوديني‬ ‫املرضى‬ ‫لدى‬ ‫املرض‬ ‫وطبيعة‬)mimics ‫عصبية‬ ‫أعراض‬ ‫حدوث‬ ‫عند‬ ‫الرياض،‬-‫الطبية‬ ‫عبدالعزيز‬ ‫امللك‬ ‫مدينة‬ ‫في‬ ‫الدماغية.‬ ‫بالسكتة‬ ‫لالشتباه‬ ‫تؤدي‬ ‫مفاجئة‬ Objectives: To study the prevalence and nature of stroke mimics)SM(among Saudi patients who came to the emergency department with a sudden neurological deficit and suspected stroke. Original Articles Methods: The electronic health records from February 2016 to July 2018 of patients who were admitted to the Stroke Unit at King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia)KAMC-RD(with a suspected stroke were all reviewed. A comparison between SM and stroke was established. Our study identified the predictors of SM by using logistic regression analysis. This study was approved by the local institutional review board. Results: Out of 1,063 patients, 131)12.3%(had SM. The most common causes were a peripheral vestibular disorder)27.4%(followed by psychogenic causes)24.4%(. Stroke mimics were more common among younger individuals and women. Arterial hypertension, diabetes, and smoking were less likely to be found in SMs. At discharge, individuals with SM were more likely to be independent, had milder deficits, and shorter hospital stays. Predictors of SM were young age, female gender, mild deficit at presentation, and good functional status before the stroke. Conclusion: The incidence of stroke mimics is common among suspected stroke patients. Practicing physicians should consider potential diagnostic errors, particularly in the hyperacute phase of the stroke.

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Section: Disclosurementioning

confidence: 99%

Stroke mimics: Clinical characteristics and outcome

Khathaami

Alsaif

Bdah

et al. 2020

NSJ

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“…Hvis hjerneslag eller transitorisk iskemisk attakk (TIA) er sannsynlig eller mulig årsak til svimmelhet, er MR den beste undersøkelsen for å verifisere diagnosen, eventuelt gjentatt etter to døgn for å bedre sensitiviteten (6). Hvis man er innenfor tidsvinduet for trombolytisk behandling/trombektomi, anbefaler vi CT for å utelukke blødning, samt CTangiografi for å se etter okklusjon i vertebralis-basilariskretsløpet.…”

Section: Radiologiske Undersøkelserunclassified

“…Dette behandles poliklinisk med reponeringsmanøvre. Ved funn av atypisk nystagmus ved posisjonstester anbefaler vi MR-undersøkelse av hjernen for å utelukke hjerneslag eller tumor (6,9). Systolisk blodtrykksfall på minst 20 mm Hg innen tre minutter i oppreist stilling tyder på ortostatisk hypotensjon.…”

Section: Episodisk Svimmelhetunclassified

Utredning ved akutt svimmelhet

Ljøstad¹,

Eldøen²,

Goplen³

et al. 2019

Tidsskriftet

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“…Approximately 4% of emergency department (ED) visits are for dizziness. [1][2][3] Strokes are the underlying cause of approximately 3 to 5% of such visits. 3 In an office-based practice, dizziness is likely at least as prevalent, though the proportion with serious causes is less clear.…”

mentioning

confidence: 99%

“…[1][2][3] Strokes are the underlying cause of approximately 3 to 5% of such visits. 3 In an office-based practice, dizziness is likely at least as prevalent, though the proportion with serious causes is less clear. With an eye toward parsimonious resource utilization, physicians must distinguish the large majority of dizzy patients with self-limiting or easily treatable conditions from the minority with life-or brain-threatening problems.…”

mentioning

confidence: 99%

Acute Dizziness

Edlow

Gurley

2019

Semin Neurol

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Dizziness is a common chief complaint with an extensive differential diagnosis that includes both benign and serious conditions. Physicians must distinguish the majority of patients who suffer from self-limiting conditions from those with serious illnesses that require acute treatment. The preferred approach to the diagnosis of an acutely dizzy patient emphasizes different aspects of the history to guide a focused physical examination, with the goal of differentiating benign peripheral vestibular conditions from dangerous posterior circulation strokes. Currently, misdiagnoses are frequent and diagnostic testing costs are high. This partly relates to use of an outdated diagnostic paradigm. This commonly used traditional approach relies on dizziness “symptom quality” or “type” (vertigo, presyncope, disequilibrium) to guide inquiry. It does not distinguish benign from dangerous causes and is inconsistent with current best evidence. A better approach categorizes patients into three groups based on timing and triggers. Each category has its own differential diagnosis and targeted bedside approach: (1) acute vestibular syndrome, where bedside physical examination differentiates vestibular neuritis from stroke; (2) spontaneous episodic vestibular syndrome, where associated symptoms help differentiate vestibular migraine from transient ischemic attack; and (3) triggered episodic vestibular syndrome, where the Dix-Hallpike and supine roll test help differentiate benign paroxysmal positional vertigo from posterior fossa structural lesions. The “timing and triggers” diagnostic approach for the acutely dizzy derives from current best evidence and offers the potential to reduce misdiagnosis while simultaneously decreasing diagnostic test overuse, unnecessary hospitalization, and incorrect treatments.

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Diagnosing Stroke in Acute Dizziness and Vertigo

Cited by 130 publications

References 75 publications

Stroke mimics: Clinical characteristics and outcome

Stroke mimics: Clinical characteristics and outcome

Utredning ved akutt svimmelhet

Acute Dizziness

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