Ischemic Stroke Predictors in Patients Presenting with Dizziness, Imbalance, and Vertigo

Kim, Yongwoo; Faysel, Mohammad; Balucani, Clotilde; Yu, Daohai; Gilles, Nadege; Levine, Steven R.

doi:10.1016/j.jstrokecerebrovasdis.2018.08.002

Cited by 13 publications

(7 citation statements)

References 15 publications

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“…The observation that rotatory dizziness is associated with a reduced risk of a time-sensitive condition is supported to some extent by previous research [14,17].…”

Section: Discussionsupporting

confidence: 68%

Prehospital Prediction of a Time-sensitive Condition Among Patients With Dizziness Assessed by the Emergency Medical Service 

Magnusson¹,

Gärskog²,

Lökholm³

et al. 2020

Preprint

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Background: Dizziness is a relatively common symptom among patients who call for the emergency medical service (EMS).Methods: All patients assessed by the EMS and triaged using the rapid emergency triage and treatment system for adults code 11 (=dizziness) in the 660,000 inhabitants in the Municipality of Gothenburg, Sweden, in 2016, were considered for inclusion. The patients were divided into two groups according to the final diagnosis (a time-sensitive condition, yes or no).Results: There were 1,536 patients who fulfilled the inclusion criteria, of which 96 (6.2%) had a time-sensitive condition. The majority of these had an acute cerebrovascular disease. Eight predictors of a time-sensitive condition were identified. Three were associated with a reduced risk: 1) the dizziness was of a rotatory type, 2) the dizziness had a sudden onset and 3) increasing body temperature. Five were associated with an increased risk: 1) sudden onset of headache, 2) a history of head trauma, 3) symptoms of nausea or vomiting, 4) on treatment with anticoagulants and 5) increasing systolic blood pressure.Conclusion: Among 1,536 patients who were assessed by the EMS due to dizziness, 6.2% had a time-sensitive condition. On the arrival of the EMS, eight factors were associated with the risk of having a time-sensitive condition. They were linked to the type of symptoms, to clinical findings on the arrival of the EMS and to the recent clinical history.

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“…The observation that rotatory dizziness is associated with a reduced risk of a time-sensitive condition is supported to some extent by previous research [14,17].…”

Section: Discussionsupporting

confidence: 68%

Prehospital Prediction of a Time-sensitive Condition Among Patients With Dizziness Assessed by the Emergency Medical Service 

Magnusson¹,

Gärskog²,

Lökholm³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The nomogram prediction model incorporated eight variables. Consisting with the literature, the variables of "isolated symptom" and "history of brief dizziness" were inversely associated with stroke onset while "male" and "high blood pressure" on admission were associated with a high risk of stroke in our study (44,45,66,67). "Nausea" and "tandem gait test" were selected as predictors in a stroke risk stratification method for the first time.…”

Section: Discussionmentioning

confidence: 78%

“…We searched for predictors of stroke from keynote papers (3,31,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). Candidate predictors were identified when the factors were consistently reported in predictive research on patients with dizziness, easily ascertained, and routine diagnostic tests for patients with stroke.…”

Section: Predictor Variablesmentioning

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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“…1 However, there may be other causes of vertigo, especially in the inner ear diseases (atherosclerosis, cholesteatomas, tumors). [2][3][4] Cerebral perfusion decreasing below a critical level is important as it can cause neurological findings. A decrease in cerebral blood flow below 10 mL/100 g to brain tissue results in an infarction.…”

Section: Original Researchmentioning

confidence: 99%

The Relationship Between Posterior Communicating Artery Formation and Vertebral Artery Flow Parameters

Yeniçeri

Bek

Çullu

et al. 2021

Journal of Diagnostic Medical Sonography

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Objectives: It is important to know the range of normal vertebral artery (VA) flow volume. Diminished VA flow volume is associated with vertebrobasilar insufficiency. The study aim was to investigate the relationship between the posterior communicating artery (PCoA) calibration and the VA flow parameters, in patients with no underlying cerebrovascular disease, below 50 years of age. Materials and Methods: The study population consisted of 102 cases below 50 years of age. The basilar artery (BA), internal carotid artery (ICA), and the PCoA calibrations were measured with magnetic resonance angiography. The VA flow parameters (maximum systolic velocity, end-diastolic velocity, mean velocity, VA flow volume, and VA calibration) were measured with duplex sonography. Results: There was no statistically significant difference between these two imaging groups, in terms of VA Vmax, VA flow volumes, VA calibrations, and BA calibrations. However, the mean right ICA and mean left ICA calibrations were significantly higher in group 2 than group 1 ( P < .01). There was no significant correlation between mean PCoA calibration and mean Vmax, mean calibration, and the total flow volume of vertebral arteries. Conclusion: The findings indicate that the VA flow rate may be relatively maintained, regardless of PCoA measurements in this study.

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Ischemic Stroke Predictors in Patients Presenting with Dizziness, Imbalance, and Vertigo

Cited by 13 publications

References 15 publications

Prehospital Prediction of a Time-sensitive Condition Among Patients With Dizziness Assessed by the Emergency Medical Service

Prehospital Prediction of a Time-sensitive Condition Among Patients With Dizziness Assessed by the Emergency Medical Service

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

The Relationship Between Posterior Communicating Artery Formation and Vertebral Artery Flow Parameters

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Ischemic Stroke Predictors in Patients Presenting with Dizziness, Imbalance, and Vertigo

Cited by 13 publications

References 15 publications

Prehospital Prediction of a Time-sensitive Condition Among Patients With Dizziness Assessed by the Emergency Medical Service&nbsp;

Prehospital Prediction of a Time-sensitive Condition Among Patients With Dizziness Assessed by the Emergency Medical Service&nbsp;

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

The Relationship Between Posterior Communicating Artery Formation and Vertebral Artery Flow Parameters

Contact Info

Product

Resources

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Prehospital Prediction of a Time-sensitive Condition Among Patients With Dizziness Assessed by the Emergency Medical Service

Prehospital Prediction of a Time-sensitive Condition Among Patients With Dizziness Assessed by the Emergency Medical Service