Post-stroke dizziness in anterior vs. posterior circulation ischemic stroke

Dizziness in anterior circulation stroke (ACS) has not been well characterized. We aimed to examine the frequency of dizziness and its associated factors in ACS, and to compare these findings with posterior circulation stroke (PCS).

We prospectively enrolled consecutive patients with acute ischemic stroke from July 2021 to July 2022, categorized into ACS and PCS groups. The presence of new-onset dizziness was assessed within 7 days of stroke onset in clinically stable patients, excluding those with severe deficits that precluded survey completion. Clinical variables, depressive symptoms (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), and neuroimaging findings were collected. Multivariable logistic regression analyses were performed to identify factors independently associated with dizziness.

Among 169 patients (98 ACS, 71 PCS), dizziness was reported in 45.9% of patients with ACS and 60.6% of those with PCS. In the ACS group, the presence of cerebral microbleeds [adjusted odds ratio (aOR) = 3.19, 95% confidence interval (CI) 1.09-9.32, p = 0.034] or a higher number of microbleeds (aOR = 2.38, 95% CI 1.10-5.15, p = 0.026) were independently associated with dizziness. In the PCS group, dizziness was independently associated with medullary or cerebellar lesions (aOR = 3.13, 95% CI 1.01-9.74, p = 0.048).

Dizziness was common in patients with ACS, with a frequency comparable to that in PCS. The absence of an association with depressive or anxiety symptoms, together with the link to cerebral microbleeds, suggests that dizziness in ACS may reflect underlying structural or vascular mechanisms, warranting greater clinical attention.