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Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study.

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Bedside assessments, including the ABCD(2) score and ocular motor examination, effectively risk-stratify acute stroke in patients with dizziness. This approach helps identify high-risk individuals for timely intervention.

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Diagnostic Imaging

Background:

  • Acute dizziness is a common presentation in emergency departments.
  • Accurate risk stratification is crucial for identifying patients with acute stroke.
  • Existing methods may not fully capture stroke risk in dizziness presentations.

Purpose of the Study:

  • To evaluate the utility of bedside clinical information in risk stratifying stroke among patients presenting with acute dizziness.
  • To assess the performance of the ABCD(2) score, ocular motor (OM) assessment, and general neurologic examination in identifying stroke.

Main Methods:

  • A surveillance study identified patients with acute dizziness, nystagmus, or imbalance, excluding specific conditions.
  • Stroke was confirmed by MRI within 14 days of symptom onset.
  • Bedside data included history, ABCD(2) score, OM assessment (head impulse test, nystagmus, skew test), and general neurologic exam.
  • Multivariable logistic regression analyzed associations, and model calibration used low, intermediate, and high-risk categories.

Main Results:

  • Acute stroke occurred in 10.7% (29/272) of patients.
  • ABCD(2) score (OR 1.74), other central nervous system (CNS) features (OR 2.54), and OM assessment (OR 2.82) were associated with stroke.
  • No stroke cases were in the low-risk category (0%), while 9.6% in moderate and 21.7% in high-risk categories had stroke.

Conclusions:

  • A combination of bedside assessments, including the ABCD(2) score, general neurologic exam, and specialized OM examination, can effectively risk-stratify acute stroke in dizziness presentations.
  • This integrated bedside approach aids in identifying patients who require further investigation, particularly those in moderate to high-risk categories.