Falls and Fear of Falling in Minor Stroke Patients With Vestibular Symptoms: A Longitudinal Observational Study

Although stroke survivors are known to have an increased risk of chronic balance dysfunction and falls, prospective studies focusing on long-term fall risk in mild stroke patients-especially those with acute vestibular symptoms-remain limited. This prospective study aimed to longitudinally characterize vestibular symptom resolution patterns within 1 year in minor stroke patients and identify predictors of the long-term risk of falls or fear of falling (FoF).

This prospective observational study recruited 242 patients with acute minor stroke presenting vestibular symptoms between September 2021 and December 2022. Vestibular symptom progression was systematically assessed at discharge, 3, 6, and 12 months poststroke. Functional outcomes were quantified using the modified Rankin Scale (mRS), while balance confidence and psychological status were evaluated with standardized instruments at each follow-up. Longitudinal analysis tracked vestibular symptom evolution over 12 months. Multivariable logistic regression identified independent predictors of falls and FoF.

Among 242 minor stroke patients with acute vestibular symptoms, symptom persistence rates progressively declined from 56.20% at discharge to 30.99% at 3 months, 26.45% at 6 months, and 16.12% at 1-year follow-up. Multivariable regression revealed that a total small vessel disease (SVD) score ≥ 2 (odds ratios [OR] = 5.106, 95% confidence intervals [CI]: 1.747-14.921, p = 0.003) independently predicted 1-year fall risk. Notably, both persistent vestibular symptomsnd the presence of anxiety/depression poststroke were significantly associated with increased risks of falls and FoF.

Vestibular symptoms resolution in minor stroke follows a biphasic trajectory, with rapid early improvement and slower late recovery. Importantly, temporal lobe involvement, SVD score ≥ 2, persistent vestibular symptoms, and anxiety/depression are independent predictors of long-term fall risk. The findings highlight the clinical value of early SVD marker identification and regular monitoring of both vestibular function and emotional status.