Abstract T P214: Early Identification Of Cerebrovascular Events In Patients Presenting With Vertigo Or Dizziness
Patients with posterior circulation strokes can present with dizziness symptoms. We aimed to identify risk factors associated with cerebrovascular events (CVE) for a subset of patients who presented with a chief complaint of vertigo or dizziness
Methods: We reviewed records of 883 consecutive patients whose admission diagnosis was coded as vertebrobasilar artery syndrome (ICD-9 code 435.3). Isolation was defined as vertigo or dizziness with no other stroke screening terms or accompanying neurologic signs or symptoms
Results: 19 were excluded because the primary complaint was not vertigo or dizziness. Among the remaining 864, the diagnosis was changed to stroke in 25 (20 posterior, 5 anterior), TIA in 11, ICH in 4 and others in 22. Comparing patients whose diagnosis was later changed to a CVE (stroke, TIA or ICH) vs. those whose diagnosis was either not changed or changed to a non-cerebrovascular one(40 vs. 824), we found that CVE was associated with acute onset (75% vs. 48%, p=0.001), dysarthria (13% vs. 2%, p=0.001), gait instability (60% vs. 39%, p=0.008), Babinski’s sign (10% vs. 3%, p=0.025), numbness (20% vs. 7%, p=0.008), consciousness disturbance (13% vs. 3%, p=0.015) and previous TIA (10% vs. 2%, p=0.011). No CVE was associated with isolation (55% vs. 28%, p=0.001) and intermittent frequency (67% vs. 53%, p=0.059). On multivariate analysis, isolation (p=0.044), acute onset (p=0.011), dysarthria (p=0.017), and previous TIA (p=0.029) remained significant. The c-statistic of the ABCD score was 0.60 (95% CI, 0.52-0.69) and that of the Framingham risk score was 0.59 (0.50-0.69). For patients with isolated vertigo or dizziness (11 vs. 455), acute onset of the chief complaint (91% vs. 46%, p=0.003), dysmetria (27% vs. 3%, p=0.004), Romberg sign (46% vs. 13%, p=0.01) and SBP at presentation (155 vs. 135, p=0.034) were associated with a CVE. On multivariate analysis, acute onset (p=0.034) and dysmetria (p=0.049) remained significant
Conclusion: clinical characteristics could be more important than cardiovascular risk factors in identifying a cerebrovascular cause in patients presenting with dizziness symptoms. For those with isolated vertigo or dizziness, acute onset and dysmetria should raise concern for a CVE that may benefit from early intervention
Author Disclosures: H. Bai: None. Y. Xiao: None. X. Zhao: None. Y. Zou: None. N. Yang: None. Y. Jiang: None. J. Xiang: None. Y. Shu: None. D. Qiu: None. L. Yang: None.
- © 2015 by American Heart Association, Inc.