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Risk of stroke is low after transient ischemic attack presentation with isolated dizziness.

Anand K Bery1, Mukul Sharma2, Marie-Joe Nemnom3

  • 1Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

CJEM
|October 19, 2022
PubMed
Summary

The risk of stroke after emergency department visits for isolated dizziness, diagnosed as transient ischemic attack (TIA), is low. Patients with isolated dizziness had a significantly lower risk of subsequent stroke and TIA within 90 days.

Keywords:
DiagnosisDizzinessStrokeVertigo

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Clinical Epidemiology

Background:

  • Stroke diagnosis is challenging when presenting as dizziness due to similar benign conditions.
  • The risk of stroke following episodic dizziness is not well-established, leading to varied clinical guidance.
  • Previous studies suggest dizziness history predicts lower stroke risk.

Purpose of the Study:

  • To evaluate the risk of stroke within 90 days after emergency department (ED) assessment for isolated dizziness, diagnosed as transient ischemic attack (TIA).

Main Methods:

  • Prospective, multicenter cohort study involving 13 Canadian EDs over 11 years.
  • Enrolled patients diagnosed with TIA, comparing isolated dizziness to other neurological deficits.
  • Primary outcome: stroke within 90 days; secondary outcomes: stroke at 2, 7, 30 days, and TIA within 90 days.

Main Results:

  • Only 0.8% of isolated dizziness patients experienced stroke within 90 days, versus 2.9% with other neurological signs (RR 0.29).
  • The probability of stroke within 90 days differed significantly between groups (p=0.007).
  • Subsequent TIA was also less common in the isolated dizziness group (1.7% vs. 5.6%, RR 0.30).

Conclusions:

  • The risk of subsequent stroke is low for patients presenting to the ED with isolated dizziness diagnosed as TIA.
  • Isolated dizziness as a presenting symptom for TIA suggests a lower risk profile compared to other neurological deficits.