Vertigo Due to Vascular Mechanisms.

Area of Science:

• Neurology
• Vascular Neurology
• Neuro-otology

Background:

• Vascular-induced dizziness and vertigo are commonly misdiagnosed as peripheral vestibulopathy or vestibular migraine.
• Accurate diagnosis is crucial for timely intervention and preventing long-term neurological deficits.

Purpose of the Study:

• To differentiate vascular causes of acute vestibular syndrome from peripheral etiologies.
• To highlight diagnostic tools for both prolonged and transient vascular vestibular events.

Main Methods:

• Clinical examination using the HINTS (Head Impulse test, Nystagmus, Skew deviation) algorithm for prolonged vestibular syndrome.
• Evaluation of associated symptoms like hearing loss, craniocervical pain, and focal neurological signs.
• Utilization of vascular imaging and MRI (perfusion- and diffusion-weighted) for transient syndromes or high-risk patients.

Main Results:

• Clinical HINTS examination is more sensitive than neuroimaging for diagnosing prolonged (≥ 24 hours) vestibular strokes.
• Anterior inferior cerebellar artery strokes require additional assessment for hearing loss in patients with prolonged vestibulopathy.
• Transient (< 24 hours) vascular vestibular syndromes are suggested by craniocervical pain and focal neurological deficits, necessitating vascular imaging in high-risk individuals.

Conclusions:

• The HINTS exam is a vital bedside tool for diagnosing acute prolonged vestibular strokes.
• Unexplained hearing loss alongside prolonged vestibulopathy warrants investigation for specific vascular causes.
• Prompt vascular imaging and MRI are essential for transient vestibular syndromes in patients with vascular risk factors.