When is Isolated Vertigo a Harbinger of Stroke?

Abstract

Isolated vertigo is usually a distressing though benign clinical entity. Recently, however, it has been recognized that in a subset of patients isolated vertigo may be a harbinger of vertebrobasilar stroke. Recognition of this “at risk” subgroup may be difficult. Brainstem auditory evoked potentials (BAEPs) are usually normal in patients with vertigo from labyrinthine disease. We describe a patient with isolated vertigo, in whom BAEPs were abnormal, and who subsequently developed an anterior inferior cerebellar artery territory infarct. BAEP testing might lead to early recognition of those patients at risk for catastrophic stroke, and prompt appropriate investigation and treatment to prevent this outcome.

Auditory disturbance as a prodrome of anterior inferior cerebellar artery infarction

“…[10][11][12][13][14][15][16][17] There have been few reports of an acute auditory syndrome as an initial manifestation of vertebrobasilar insufficiency. In 1981, Stephan et al described a patient with sudden bilateral hearing loss caused by basilar artery occlusion who later developed multiple brain stem dysfunctions with quadriplegia and mental change.…”

Vertigo in Cerebrovascular Diseases

“…Thus vertebrobasilar territory stroke should be considered in patients with vascular risk factors presenting with isolated vertigo even in the absence of brain stem or cerebellar signs. 16,19,23 …”