Vertigo in patients with cancer: Red flag symptoms

Vertigo is a common condition occurring in the general population and is usually self-limited. Reports studying vertigo in patients with brain metastasis (BM), are scarce. Therefore, the aim of this study was to analyze if the presence of vertigo in cancer patients is associated with the presence of BM.

This study was conducted in a cancer referral center, where patients with confirmed systemic cancer sent for a neuro-oncologic consultation from May 2012 to March 2018 were included for review.

Of 3220 patients, 723 were diagnosed with BM, and 204 had vertigo. Of these patients, 22.5% of those who had vertigo were diagnosed to have BM and 6% of those with BM had vertigo as an initial symptom (odds ratio [OR] 0.9; p = 0.9). An additional symptom was present in 104 patients with vertigo. Bivariate regression analysis disclosed a higher risk of having BM in patients with vertigo accompanied by headache (OR18.6; p < 0.0001), ataxia (OR12.1; p < 0.0001), seizures (OR10.9; p = 0.04), visual symptoms (OR10.4; p < 0.0001), speech impairment (OR6.3; p = 0.01), altered mental status (OR7.4; p < 0.0001), and focal weakness (OR7.4; p = 0.001), or focal sensitive complaint (OR6.9; p = 0.003). Vertigo with headache or ataxia remained statistically significant after multivariate analysis.

In this cohort, a higher risk of having BM was associated with the presence of vertigo coexistent with headache, ataxia, seizures, visual symptoms, speech impairment, altered mental status, focal weakness, or focal sensitive complaint. On the basis of these results, these accompanying symptoms must be considered as red flags in patients with systemic cancer.