Small strokes causing severe vertigo

Tehrani, Ali S. Saber; Kattah, Jorge C.; Mantokoudis, Georgios; Pula, John H.; Nair, Deepak; Blitz, Ari M.; Ying, Sarah H.; Hanley, Daniel F.; Zee, David S.; Newman‐Toker, David E.

doi:10.1212/wnl.0000000000000573

Cited by 224 publications

(173 citation statements)

References 22 publications

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“…This forms the basis of the 'HINTS' protocol (Head-impulse, Nystagmus, Test-skew) which has at least as much sensitivity to rule out posterior fossa stroke as MRI does. 5,6 Additional brainstem VOR mechanisms The VOR is under powerful cerebellar control and this is reviewed by Zee in this issue. Indeed many 'cerebellar' eye signs are actually vestibulo-cerebellar signs, including the common syndrome of downbeat nystagmus.…”

Section: Basic Clinical Anatomy Of the Vormentioning

confidence: 99%

A brief review of the clinical anatomy of the vestibular-ocular connections—how much do we know?

Bronstein

Patel

Arshad

2014

Eye

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The basic connectivity from the vestibular labyrinth to the eye muscles (vestibular ocular reflex, VOR) has been elucidated in the past decade, and we summarise this in graphic format. We also review the concept of 'velocity storage', a brainstem integrator that prolongs vestibular responses. Finally, we present new discoveries of how complex visual stimuli, such as binocular rivalry, influence VOR processing. In contrast to the basic brainstem circuits, cortical vestibular circuits are far from being understood, but parietal-vestibular nuclei projections are likely to be involved.

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Section: Basic Clinical Anatomy Of the Vormentioning

confidence: 99%

A brief review of the clinical anatomy of the vestibular-ocular connections—how much do we know?

Bronstein

Patel

Arshad

2014

Eye

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“…Focal lesion in the cortical or subcortical as well as brainstem or cerebellum is the most common causes of central AVS [1][2][3][4]10,11,15], but brain ischemia, hypoxia, poisoning, metabolic disorder, and malnutrition is also the factors of brain dysfunction caused by the lesions of vestibular central pathways [5][6][7][8][9][12][13][14]16].…”

Section: Discussionmentioning

confidence: 99%

“…There are many reasons for central AVS. The most common causes are acute ischemic stroke [1,2], followed by spontaneous intra cerebral hemorrhage [1,3]. Perhaps, there are many other well-known reasons for the first symptom that commonly precipitate central AVS, such as migraineous vertigo [4], heart disease [5], acute drug poisoning or adverse reactions (including carbon monoxide, phenytoin, antihypertensive drugs and antitumor drugs) [6][7][8][9], vertigo epilepsy [10], and multiple sclerosis [11].…”

Section: Introductionmentioning

confidence: 99%

Initial Presenting as Acute Vertigo Syndrome in Sepsis Associated Encephalopathy: A Retrospective Case Series

Tong¹

2017

SOJN

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Objective: To investigate whether sepsis associated encephalopathy (SAE) is a cause of acute vertigo syndrome (AVS). Methods:From Jen 2014 to Des 2016 period, the clinical data in 7 patients who were from a hospital intensive care unit (ICU), because of misdiagnosed SAE whose complaint was vertigo or dizziness, was retrospectively analyzed.Results: Among 7 misdiagnosed SAE patients, 5 were male and 2 were female, with a median age of 60 years (range, 23-82 years). All patients presented with AVS at onset. Of them, transient or recurrent AVS occurred in 6 patients, and persistent AVS in 1case. 3 patients by brain angiography showed the ischemic lesions in the central vestibular partway, however, all of 7 cases with AVS presented a central vestibular impaired mechanism from septic shock or sepsis, supporting AVS was a central AVS. The patient 1 only presented isolated central AVS and with no others brain dysfunction, so met the diagnosis of mild SAE, and with a favorable prognosis. The other 6 cases developed from mild brain dysfunction (central AVS) to deep coma and multiple organ failure, met the diagnosis of severe SAE with multiple organ failure, and all of them died eventually.Conclusions: SAE might be a little-known cause of the central AVS. A recognition of this issue facilitate earlier identification and more timely treatment in patients with AVS with SAE.

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“…50% of patients with a stroke who present with isolated vertigo will have a falsely negative MRI up to 48 hours after onset. 25 A recent article by Simonsen et al found DWI negative strokes were twice as likely in the posterior circulation (34% vs 15%), but the sensitivity of DWI seems variable within the literature. 31,32 The sensitivity of MRI increases with time from symptom onset to imaging.…”

Section: Special Topics In Imaging Of Bao and Posterior Fossamentioning

confidence: 99%

Basilar Occlusion Syndromes

Demel

Broderick

2015

The Neurohospitalist

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Basilar artery occlusions (BAOs) are a subset of posterior circulation strokes. Particular issues relevant to BAOs include variable and stuttering symptoms at onset resulting in delays in diagnosis, high morbidity and mortality, and uncertain best management. Despite better imaging techniques, diagnosis, and therefore treatment, is often delayed. We will present the most common signs and symptoms of posterior circulation strokes. Data on optimal treatment strategies are gathered from multiple case series, registries, and one randomized trial, which was stopped early. Possible etiologies of BAOs, acute, and subacute treatment strategies and special topics in neuroimaging of the posterior fossa are discussed. This review may be helpful to neurohospitalists who are managing patients with acute stroke as well as emergency room physicians and neurologists.

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Small strokes causing severe vertigo

Cited by 224 publications

References 22 publications

A brief review of the clinical anatomy of the vestibular-ocular connections—how much do we know?

A brief review of the clinical anatomy of the vestibular-ocular connections—how much do we know?

Initial Presenting as Acute Vertigo Syndrome in Sepsis Associated Encephalopathy: A Retrospective Case Series

Basilar Occlusion Syndromes

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