TY - JOUR
T1 - Cerebellar stroke presenting with isolated dizziness
T2 - Brain MRI in 136 patients
AU - Perloff, Michael D.
AU - Patel, Nimesh S.
AU - Kase, Carlos S.
AU - Oza, Anuja U.
AU - Voetsch, Barbara
AU - Romero, Jose R.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/11
Y1 - 2017/11
N2 - Objective To evaluate occurrence of cerebellar stroke in Emergency Department (ED) presentations of isolated dizziness (dizziness with a normal exam and negative neurological review of systems). Methods A 5-year retrospective study of ED patients presenting with a chief complaint of “dizziness or vertigo”, without other symptoms or signs in narrative history or on exam to suggest a central nervous system lesion, and work-up included a brain MRI within 48 h. Patients with symptoms commonly peripheral in etiology (nystagmus, tinnitus, gait instability, etc.) were included in the study. Patient demographics, stroke risk factors, and gait assessments were recorded. Results One hundred and thirty-six patients, who had a brain MRI for isolated dizziness, were included. There was a low correlation of gait assessment between ED physician and Neurologist (49 patients, Spearman's correlation r2 = 0.17). Based on MRI DWI sequence, 3.7% (5/136 patients) had acute cerebellar strokes, limited to or including, the medial posterior inferior cerebellar artery vascular territory. In the 5 cerebellar stroke patients, mean age, body mass index (BMI), hemoglobin A1c, gender distribution, and prevalence of hypertension were similar to the non-cerebellar stroke patient group. Mean LDL/HDL ratio was 3.63 ± 0.80 and smoking prevalence was 80% in the cerebellar stroke group compared to 2.43 ± 0.79 and 22% (respectively, p values < 0.01) in the non-cerebellar stroke group. Conclusions Though there was preselection bias for stroke risk factors, our study suggests an important proportion of cerebellar stroke among ED patients with isolated dizziness, considering how common this complaint is.
AB - Objective To evaluate occurrence of cerebellar stroke in Emergency Department (ED) presentations of isolated dizziness (dizziness with a normal exam and negative neurological review of systems). Methods A 5-year retrospective study of ED patients presenting with a chief complaint of “dizziness or vertigo”, without other symptoms or signs in narrative history or on exam to suggest a central nervous system lesion, and work-up included a brain MRI within 48 h. Patients with symptoms commonly peripheral in etiology (nystagmus, tinnitus, gait instability, etc.) were included in the study. Patient demographics, stroke risk factors, and gait assessments were recorded. Results One hundred and thirty-six patients, who had a brain MRI for isolated dizziness, were included. There was a low correlation of gait assessment between ED physician and Neurologist (49 patients, Spearman's correlation r2 = 0.17). Based on MRI DWI sequence, 3.7% (5/136 patients) had acute cerebellar strokes, limited to or including, the medial posterior inferior cerebellar artery vascular territory. In the 5 cerebellar stroke patients, mean age, body mass index (BMI), hemoglobin A1c, gender distribution, and prevalence of hypertension were similar to the non-cerebellar stroke patient group. Mean LDL/HDL ratio was 3.63 ± 0.80 and smoking prevalence was 80% in the cerebellar stroke group compared to 2.43 ± 0.79 and 22% (respectively, p values < 0.01) in the non-cerebellar stroke group. Conclusions Though there was preselection bias for stroke risk factors, our study suggests an important proportion of cerebellar stroke among ED patients with isolated dizziness, considering how common this complaint is.
KW - Cerebellar stroke
KW - Dizzy
KW - Isolated dizziness
KW - MRI DWI
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U2 - 10.1016/j.ajem.2017.06.034
DO - 10.1016/j.ajem.2017.06.034
M3 - Article
C2 - 28687453
AN - SCOPUS:85021830543
SN - 0735-6757
VL - 35
SP - 1724
EP - 1729
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 11
ER -