Vertigo in Cerebrovascular Diseases
Rahul T Chakor, Nishikant Eklare
Cerebrovascular disease,Stroke,Vertebrobasilar territory,Vertigo
Citation Information :
Chakor RT, Eklare N. Vertigo in Cerebrovascular Diseases. Int J Otorhinolaryngol Clin 2012; 4 (1):46-53.
Copyright © 2012; Jaypee Brothers Medical Publishers (P) Ltd.
Vertigo as a symptom of cerebrovascular disease is relatively uncommon. All types of cerebrovascular diseases namely ischemia, infarction, hemorrhage can produce vertigo. Since, cerebrovascular disease is an emergency prompt recognition and treatment is necessary to prevent neurologic deficit and death. Among cerebrovascular diseases vertebrobasilar territory strokes commonly present with vertigo. Since, the term vertigo is used nonspecifically by patients this may lead to delay in diagnosis of these strokes. This article reviews the epidemiology of vertigo in cerebrovascular diseases and the various stroke syndromes associated with vertigo.
Cerebrovascular diseases in the vertebrobasilar territory have vertigo, imbalance, dizziness in addition to other symptoms and signs. Posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery and basilar artery territory strokes can present with true vertigo. A high index of suspicion of stroke in patients with vertigo and risk factors for stroke is essential. Other vascular causes of vertigo are small cerebellar hemorrhage, vestibular cortex stroke, rotational vertebral artery syndrome, transverse/sigmoid sinus thrombosis and vestibular paroxysmia.
Cerebrovascular disorders are estimated to account for 3 to 4% of patients with vertigo or dizziness. Early detection and treatment is necessary to prevent disability and death in these cases of vascular vertigo.
How to cite this article
Chakor RT, Eklare N. Vertigo in Cerebrovascular diseases. Int J Otorhinolaryngol Clin 2012;4(1):46-53.
Designing a message for public education regarding stroke: Does FAST capture enough stroke? Stroke 2007Oct;38(10):2864–68.
Atypical presentations of acute cerebrovascular syndromes. Lancet Neurol 2011 Jun;10(6):550–60.
The atlas of heart disease and stroke (1st ed). World Health Organization; 2004;112.
Shaping the future. World Health Organization 2003;216.
Factors associated with misdiagnosis of acute stroke in young adults. J Stroke Cerebrovasc Dis 2011 Nov;20(6):523–27.
Stroke among patients with dizziness, vertigo and imbalance in the emergency department: A population-based study. Stroke 2006 Sep 7;37(10):2484–87.
Isolated vertigo and dizziness of vascular origin. J Otolaryngol Head Neck Surg 2008 Jun;37(3):331–39.
Epidemiology of vertigo. Curr Opin Neurol 2007 Feb;20(1):40–46.
Central paroxysmal positional vertigo: Isolated dizziness caused by small cerebellar hemorrhage. Stroke 2007 Jun;38(6):e26–27; author reply e28.
Spectrum of dizziness visits to US emergency departments: Cross-sectional analysis from a nationally representative sample. Mayo Clin. Proc 2008 Jul;83(7):765–75.
Churchill Livingstone 2004;1600.
Textbook of clinical neurology (3rd ed). Philadelphia: Saunders Elsevier; 2007.
The anatomical basis for the cerebellar infarcts. Surg Neurol 1995 Nov;44(5):450–460; discussion 460-461.
Cerebellar infarction. Clinical and anatomic observations in 66 cases. Stroke 1993 Jan;24(1):76–83.
Infarction in the territory of the medial branch of the posterior inferior cerebellar artery. J Neurol Neurosurg Psychiatr 1990 Sep;53(9):731–35.
Vertebrobasilar insufficiency presenting as isolated positional vertigo or dizziness: A double-blind retrospective cohort study. Laryngoscope 2009 Oct;119(10):2071–76.
Isolated nodular infarction. Stroke 2009 Feb;40(2):487–91.
Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis. Neurology 2008 Jun 10;70(24 Pt 2):2378–85.
Vertigo of vascular origin. Clinical and electronystagmographic features in 84 cases. Arch Neurol 1989 Mar;46(3):281–84.
Auditory disturbance as a prodrome of anterior inferior cerebellar artery infarction. J Neurol Neurosurg Psychiatr 2003 Dec;74(12):1644–48.
Bilateral sudden deafness as a prodrome of anterior inferior cerebellar artery infarction. Arch Neurol 2001 Aug;58(8):1287–89.
Bilateral sudden profound hearing loss and vertigo as a unique manifestation of bilateral symmetric inferior pontine infarctions. Ann Otol Rhinol Laryngol 2007 Jun;116(6):407–10.
When is isolated vertigo a harbinger of stroke? Ear Nose Throat J 1995 Jan;74(1):33–36.
Anterior inferior cerebellar artery territory infarcts. Mechanisms and clinical features. Arch Neurol 1993 Feb;50(2):154–61.
Infarction in the territory of anterior inferior cerebellar artery: spectrum of audiovestibular loss. Stroke 2009 Sep 24;40(12):3745–51.
Cerebellar infarction in the territory of the anterior and inferior cerebellar artery. A clinicopathological study of 20 cases. Brain 1990 Feb;113(Pt 1):139–55.
Cerebellar infarction presenting isolated vertigo: Frequency and vascular topographical patterns. Neurology 2006 Oct 10;67(7):1178–83.
Isolated dizziness/vertigo, vascular risk factors and stroke. Acta Neurol Taiwan 2011 Jun;20(2):75–76.
Basilar artery stenosis: Middle and distal segments. Neurology 1987 Nov;37(11):1742–46.
Isolated vertigo as a manifestation of vertebrobasilar ischemia. Neurology 1996 Jul;47(1):94–97.
The relationship between isolated dizziness/vertigo and the risk factors of ischemic stroke: A case control study. Acta Neurol Taiwan 2011 Jun;20(2):101–06.
Clinical features of proven basilar artery occlusion. Stroke 1990;21(8):1135–42.
Heralding manifestations of basilar artery occlusion with lethal or severe stroke. J Neurol Neurosurg Psychiatr 2003 Dec;74(12):1621–26.
Positional and positioning vertigo and nystagmus. J Neurol Sci 1990 Jan;95(1):3–28.
Positional vertigo and nystagmus of central origin. Can J Neurol Sci 1981 May;8(2):133–37.
Small cerebellar strokes may mimic labyrinthine lesions. J Neurol Neurosurg Psychiatr 1985 Mar;48(3):263–65.
Spontaneous labyrinthine hemorrhage in sickle cell disease. AJNR. Am J Neuroradiol 1998 Sep;19(8):1437–40.
Sudden hearing loss caused by labyrinthine hemorrhage. Braz J Otorhinolaryngol 2008 Oct;74(5):776–79.
Cerebral venous thrombosis mimicking acute unilateral vestibulopathy. Neurol Sci 2008 Feb;29(1):41–43.
Cerebellar venous infarction in chronic suppurative otitis media. A case report with review of four other cases. Stroke 1994 May;25(5):1058–60.
Cerebellar venous infarction: Case report with clinicopathologic correlation. Neurology 1990 May;40(5):837–38.
Cranial nerve syndrome in thrombosis of the transverse/sigmoid sinuses. Brain 1998 Feb;121(Pt 2):381–88.
Origin of isolated vertigo in rotational vertebral artery syndrome. Neurol Sci 2011 Dec;32(6):1203–07.
[Vestibular paroxysmia: Clinical study and treatment of eight patients]. Arq Neuropsiquiatr 2005 Sep;63(3A):643–47.
Vestibular paroxysmia: Diagnostic features and medical treatment. Neurology 2008 Sep 23;71(13):1006–14.
Vertigo and imbalance caused by a small lesion in the anterior insula. Electromyogr Clin Neurophysiol 2006 Jun;46(3):185–92.
Acute rotatory vertigo caused by a small haemorrhage of the vestibular cortex. J Neurol Neurosurg Psychiatr 2003 Mar;74(3):388.
Rotational vertigo in embolic stroke of the vestibular and auditory cortices. Neurology 1995 Jan;45(1):42–44.
Vertigo and dizziness associated with cerebral hemispheric lesions. J UOEH 2003 Jun 1;25(2): 207–15.