Vascular vertigo: updates

Abstract

Discriminating strokes in patients with acute dizziness/vertigo is challenging especially when other symptoms and signs of central nervous involvements are not evident. Despite the developments in imaging technology over the decades, a significant proportion of acute strokes may escape detection on imaging especially during the acute phase or when the lesions are small. Thus, small strokes causing isolated dizziness/vertigo would have a higher chance of misdiagnosis in the emergency department. Even though several diagnostic algorithms have been advanced for acute vascular vertigo, we still await more comprehensive and sophisticated ones that can also be applied to transient vestibular symptoms due to vascular compromise. In this respect, vascular and perfusion imaging would be informative. Application of artificial intelligence and tele-consultation may be future perspectives for real-time decision in acute dizziness and vertigo. Several new constellations of ocular motor and vestibular findings have been added to the strokes involving the brainstem and cerebellum. Defining these characteristics would help understanding the function of central vestibular structures and allow more accurate localization of the strokes involving these structures.

Consensus Paper. Cerebellar Reserve: From Cerebellar Physiology to Cerebellar Disorders

“…As expected from macaque lesion models, the ocular motor deficits in acute stroke patients should be mostly reversible. Unlike macaques that take months for resolution of ocular motor function, in typical instances the ocular motor deficits after acute stroke resolve in 48-72 h, despite sizable structural deficits noted under MRI [68][69][70][71][72]. How to explain such a disparity in time of functional reversal between macaque lesion experiments and human stroke patients?…”

Probabilistic Template of the Lateral Parabrachial Nucleus, Medial Parabrachial Nucleus, Vestibular Nuclei Complex, and Medullary Viscero-Sensory-Motor Nuclei Complex in Living Humans From 7 Tesla MRI

“…Specifically, these structures, individually or synergistically, regulate arousal (e.g., LBP, MPB) (Kaur et al, 2013), gustatory processes (e.g., VSM) (Matsumoto, 2013), sensory-motor function (VSM) (Olszewski and Baxter, 1954), and autonomic functions like cardio-respiratory (e.g., LPB and MPB) (Damasceno et al, 2014) and gastrointestinal processes (e.g., VSM) (Bokiniec et al, 2017). Clinical conditions that alter the structure or function of these nuclei, including cerebrovascular events, autoimmune diseases, trauma, stroke (Choi and Kim, 2018) and neurodegenerative disorders may produce a wide variety of symptoms and signs including disruptions of sleep and alertness, autonomic dysregulation, vertigo, and impaired control of eye movements and gait.…”

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

“…Cerebral lesions presenting with vertigo, dizziness, or double vision mostly involve vestibular and ocular motor circuits in the brainstem and cerebellum, whereas thalamo-cortical networks are affected only occasionally (6,7). The reason for this lesion distribution can be found in the functional anatomy of the bilaterally organized central vestibular system, which converts direction-specific signals of each labyrinth into more global position-in-space signals along the ascending vestibular projections (8).…”