The Incidence of Central Neurological Disorders Among Patients With Isolated Dizziness and the Diagnostic Yield of Neuroimaging Studies.
Academic Medical Centers
Adult
Aged
Brain Infarction
/ diagnostic imaging
Central Nervous System Diseases
/ diagnostic imaging
Diffusion Magnetic Resonance Imaging
/ standards
Dizziness
/ diagnostic imaging
Emergency Service, Hospital
Female
Humans
Incidence
Ischemic Attack, Transient
/ diagnostic imaging
Ischemic Stroke
/ diagnostic imaging
Male
Middle Aged
Neuroimaging
/ standards
Retrospective Studies
Tomography, X-Ray Computed
/ standards
Vertebrobasilar Insufficiency
/ diagnostic imaging
Journal
The neurologist
ISSN: 2331-2637
Titre abrégé: Neurologist
Pays: United States
ID NLM: 9503763
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
entrez:
4
7
2020
pubmed:
4
7
2020
medline:
7
4
2021
Statut:
ppublish
Résumé
Dizziness is a common symptom among emergency department (ED) patients and is often associated with benign processes. The aim of this study was to investigate the incidence of severe central neurological pathologies in isolated dizziness cases and the diagnostic efficiency of neuroimaging studies. All applications for isolated dizziness to an academic ED between January 1, 2011, and December 31, 2017 were retrospectively reviewed. The frequency of these admissions, the demographic data of the patients, the results of cranial computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) studies, and the central neurological causes of isolated dizziness were recorded. The percentage of patients with isolated dizziness among all ED admissions was 2.5% (29,510/1,190,857). The median age of these patients was 52 years (interquartile range: 38 to 66) and 58% were female. During the study period, the rate of neuroimaging studies for isolated dizziness increased year by year, and a total of 6406 (21.7%) cranial CTs and 2896 (9.8%) DW-MRIs were performed. The diagnostic yield of neuroimaging studies was 0.6% for cranial CT and 3.9% for DW-MRI. Central neurological disorders were detected in 143 (0.48%) patients with isolated dizziness. The most common causes were posterior circulation ischemic strokes (47.5%), other ischemic strokes (18.9%), vertebrobasilar insufficiency (10.5%), and transient ischemic attack (8.4%). Isolated dizziness is rarely associated with central neurological pathologies. Neuroimaging studies, especially cranial CT, have low diagnostic yield in isolated dizziness and should therefore not be routine in the evaluation process.
Identifiants
pubmed: 32618835
doi: 10.1097/NRL.0000000000000282
pii: 00127893-202007000-00001
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
85-88Références
Cheung CS, Mak PS, Manley KV, et al. Predictors of important neurological causes of dizziness among patients presenting to the emergency department. Emerg Med J. 2010;27:517–521.
Newman-Toker DE, Hsieh YH, Camargo CA Jr, et al. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc. 2008;83:765–775.
Spiegel R, Kirsch M, Rosin C, et al. Dizziness in the emergency department: an update on diagnostics. Swiss Med Wkly. 2017;147:w14565.
Saber Tehrani AS, Kattah JC, Kerber KA, et al. Diagnosing stroke in acute dizziness and vertigo: pitfalls and pearls. Stroke. 2018;49:788–795.
Jo S, Jeong T, Lee JB, et al. Incidence of acute cerebral infarction or space occupying lesion among patients with isolated dizziness and the role of D-dimer. PLoS One. 2019;14:e0214661.
Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2017;156(suppl):S1–S47.
Saber Tehrani AS, Coughlan D, Hsieh YH, et al. Rising annual costs of dizziness presentations to US emergency departments. Acad Emerg Med. 2013;20:689–696.
Ljunggren M, Persson J, Salzer J. Dizziness and the acute vestibular syndrome at the emergency department: a population-based descriptive study. Eur Neurol. 2018;79:5–12.
Kattah JC, Talkad AV, Wang DZ, et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40:3504–3510.
Kerber KA, Meurer WJ, West BT, et al. Dizziness presentations in US emergency departments, 1995-2004. Acad Emerg Med. 2008;15:744–750.
Marmol-Szombathy I, Dominguez-Duran E, Calero-Ramos L, et al. Identification of dizzy patients who will develop an acute cerebrovascular syndrome: a descriptive study among emergency department patients. Eur Arch Otorhinolaryngol. 2018;275:1709–1713.
Navi BB, Kamel H, Shah MP, et al. Rate and predictors of serious neurologic causes of dizziness in the emergency department. Mayo Clin Proc. 2012;87:1080–1088.
Kerber KA, Brown DL, Lisabeth LD, et al. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke. 2006;37:2484–2487.
Kerber KA, Meurer WJ, Brown DL, et al. Stroke risk stratification in acute dizziness presentations: a prospective imaging-based study. Neurology. 2015;85:1869–1878.
Tarnutzer AA, Lee SH, Robinson KA, et al. ED misdiagnosis of cerebrovascular events in the era of modern neuroimaging: a meta-analysis. Neurology. 2017;88:1468–1477.
Savitz SI, Caplan LR, Edlow JA. Pitfalls in the diagnosis of cerebellar infarction. Acad Emerg Med. 2007;14:63–68.
Rothwell PM, Giles MF, Chandratheva A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007;370:1432–1442.
Doijiri R, Uno H, Miyashita K, et al. How commonly is stroke found in patients with isolated vertigo or dizziness attack? J Stroke Cerebrovasc Dis. 2016;25:2549–2552.
Perloff MD, Patel NS, Kase CS, et al. Cerebellar stroke presenting with isolated dizziness: brain MRI in 136 patients. Am J Emerg Med. 2017;35:1724–1729.
Masdeu JC, Irimia P, Asenbaum S, et al. EFNS guideline on neuroimaging in acute stroke. Report of an EFNS task force. Eur J Neurol. 2006;13:1271–1283.
Chalela JA, Kidwell CS, Nentwich LM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369:293–298.