2023 Volume 82 Issue 6 Pages 509-518
Vertigo/dizziness is estimated to account for 2.5% of all emergency department (ED) visits. Although vertigo and dizziness are said to be attributable to benign vestibular disorders in most patients visiting the ER, the symptoms are attributable to dangerous causes, such as cerebrovascular disease, in a few cases (1.7%-3%). It is important to identify cases of stroke among the numerous patients with vertigo and dizziness visiting the ER, not only to overemphasize HINTS, but also to identify dizziness occurring concomitantly with other neurological symptoms. Acute vertigo and dizziness occurring in association with hemiplegia, unilateral sensory disturbance, dysarthria, oculomotor dysfunction or limb ataxia strongly suggest infratentorial strokes. Even if no neurological symptoms are noticeable in the patients presenting with vertigo and dizziness, presence of impaired standing and walking, namely truncal ataxia, should lead to the suspicion of lower cerebellar stroke. Rare cases of stroke, however, present with only nystagmus, mimicking benign paroxysmal positional vertigo and vestibular neuritis. Vertebrobasilar insufficiency, subclavian steal syndrome, and Bowhunter syndrome are atypical types of vertigo associated the risk of ischemic stroke. It should be recognized that multiple supratentorial infarcts and lateral medullary infarcts could cause chronic dizziness.
