Relation of infarction location and volume to vertigo in vertebrobasilar stroke

Abstract

Objective Vertigo is a common presentation of vertebrobasilar stroke. Anecdotal reports have shown that vertigo occurs more often in multiple than in single brainstem or cerebellar infarctions. We examined the relation between the location and volume of infarction and vertigo in patients with vertebrobasilar stroke. Methods Consecutive patients with vertebrobasilar stroke were prospectively recruited. The infarction location and volume were assessed in the diffusion‐weighted magnetic resonance imaging. Results Fifty‐nine patients were included, 32 (54.2%) with vertigo and 27 (45.8%) without vertigo. The infarction volume did not correlate with National Institute of Health Stroke Scale (NIHSS) score on admission (Spearman ρ = .077, p = .56) but correlated with modified Rankin Scale (ρ = .37, p = .004) on discharge. In the vertigo group, the proportion of men was lower (53.1% vs. 77.8%, p = .049), fewer patients had focal neurological deficits (65.6% vs. 96.3%, p = .004), patients tended to present later (median [IQR] was 7.5 [4–46] vs. 4 [2–12] hours, p = .052), numerically fewer patients received intravenous thrombolysis (15.6% vs. 37%, p = .06), and the total infarction volume was larger (5.6 vs. 0.42 cm3, p = .008) than in nonvertigo group. In multivariate logistic regression, infarction location either in the cerebellum or in the dorsal brainstem (odds ratio [OR] 16.97, 95% CI 3.1–92.95, p = .001) and a total infarction volume of >0.48 cm3 (OR 4.4, 95% CI 1.05–18.58, p = .043) were related to vertigo. In another multivariate logistic regression, after adjusting for age, sex, intravenous thrombolysis, serum level of white blood cells, and atrial fibrillation, vertigo independently predicted a total infarction volume of >0.48 cm3 (OR 5.75, 95% CI 1.43–23.08, p = .01). Conclusion Infarction location in the cerebellum and/or dorsal brainstem is an independent predictor of vertigo. Furthermore, larger infarction volume in these structures is associated with vertigo. A considerable proportion of patients with vascular vertigo present without focal neurological deficits posing a diagnostic challenge. National Institute of Health Stroke Scale is not sensitive for vertebrobasilar stroke.

Vertigo in Acute Stroke Is a Predictor of Brain Location but Is Not Related to Early Outcome: The Experience of Sagrat Cor Hospital of Barcelona Stroke Registry

“…Additionally, it is noteworthy that the presence of speech disturbances and limb weakness is not associated with the vertigo group. These results agree with those of Elhfnawy et al [ 51 ] who, in their study, found that there were fewer patients with associated neurological deficits in the vertigo group. We must differentiate our work from the interesting study published by Qiu et al [ 71 ].…”

“…In the present work, we have shown that the presence of vertigo is more frequent in non-lacunar acute stroke subtypes (atherothrombotic infarct, cardioembolic infarct, and intracerebral hemorrhage) compared to patients with lacunar infarcts, which are the subtype of ischemic stroke with a characteristic small lesional cerebral size (usually less than 15 mm maximum diameter) [ 46 , 47 , 48 , 49 , 50 ]. These results are similar to those of other studies in which an inverse relationship between volume and vertigo was demonstrated, with significantly less frequent presence of vertigo in small-sized acute strokes [ 51 , 52 , 53 , 54 , 55 , 56 ]. We speculate that larger cerebral infarcts or hemorrhages mediate the development of vascular vertigo through involvement of various posterior infratentorial brain structures and interconnections related to central vestibular connections.…”

Sex Differences in Presentation of Stroke: A Systematic Review and Meta-Analysis

“…For a subgroup analysis for sex differences in ischemic stroke, we included 18 studies with ischemic stroke only 5 , 7 , 19 , 22 , 23 , 27 , 29 , 30 , 32 , 40 , 41 , 49 , 52 , 54 , 56 , 62 , 65 , 68 and 3 studies that provided separate analyses for ischemic and hemorrhagic stroke. 17 , 39 , 44 In total, 53 226 ischemic stroke patients were included.…”

Expression of p53, bax and bcl-2 and predictive value of fibrinogen, D-Dimer, and mean platelet volume in patients with acute cerebral infarction after intravenous thrombolysis

“…Through the intravenous infusion of thrombolytic drugs, the fibrinolysis in the thrombus can be dissolved, so that the blocked blood vessels can be recanalized. This method of treatment is called IVT therapy (18)(19)(20). After a stroke occurs, IVT is administered to patients within 4.5 hours, which can save some of the brain tissue that has not yet been necrotic.…”