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Semin Neurol 2020; 40(01): 067-075
DOI: 10.1055/s-0039-3402737
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Vertigo Due to Vascular Mechanisms

Hyun Ah Kim‡   *
1   Department of Neurology, Keimyung University Dongsan Hospital, Daegu, South Korea
,
Hyung Lee‡   *
1   Department of Neurology, Keimyung University Dongsan Hospital, Daegu, South Korea
,
Ji-Soo Kim
2   Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
3   Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
› Author Affiliations Funding This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (no. NRF-2016R1D1A1B04935568).
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Publication History

Publication Date:
14 January 2020 (online)

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Abstract

Isolated dizziness and vertigo due to vascular mechanisms are frequently misdiagnosed as peripheral vestibulopathy or vestibular migraine. For diagnosis of strokes presenting with an acute prolonged (≥ 24 hours) vestibular syndrome, findings on clinical examination, such as HINTS (negative head impulse tests, detection of direction-changing gaze-evoked nystagmus, and presence of skew deviation), are more sensitive than findings on neuroimaging. Since HINTS alone cannot securely detect anterior inferior cerebellar artery strokes, additional attention should be paid to the patients with unexplained hearing loss in addition to acute prolonged vestibulopathy. For diagnosis of transient (< 24 hours) spontaneous vestibular syndrome due to vascular mechanisms, the presence of associated craniocervical pain and focal neurological symptoms/signs is the clue. Even without these symptoms or signs, however, vascular imaging combined with perfusion- and diffusion-weighted MRI should be performed in patients with multiple vascular risk factors or a high ABCD2 score (age, blood pressure, clinical features, duration of symptom, and presence of diabetes).

Keywords

dizziness - vertigo - stroke - infarction

Authors' Contributions

H.A.K. and H.L. wrote the manuscript.


J-S.K. designed and conceptualized the study and revised the manuscript.


* These authors contributed equally to this work.


 

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