Stroke (as cause of Vertigo)

Vertebro-Basilar stroke (posterior circulation) can present with Vertigo.
  • Usually other symptoms / signs [see Table below]
  • Isolated vertigo alone occurs in only 1% of posterior strokes (i.e. stroke is very unlikely if no other findings)

Also see Vertigo – 1.

SUGGESTION OF STROKE AS CAUSE OF VERTIGO

Stroke Risk Factors
  • Age >60
  • Hypertension
  • Diabetes
  • Connective tissue disorder
Stroke Symptoms (vertebro-basilar)
  • diplopia
  • dysarthria
  • dysphagia
Suggestion of Vertebral Artery Dissection
  • Severe head or neck pain
  • Recent trauma
Signs of Vertebro-Basilar Stroke on Exam
  • EOM deficit
  • Rotary or vertical nystagmus
  • Horner’s (unilateral ptosis, miosis, absent sweating)
  • Deficits in CN 9-12 (including hoarseness)
  • Unilateral deficit in coordination (finger-to-nose or heel-down-shin tests)
  • Loss of pinprick sensation involving one side of face & opposite side of trunk
  • Abnormal Romberg with eyes open (in vestibular disease, position maintained with feet together eyes open, but not eyes closed)
  • If vertigo & nystagmus actively present, a normal horizontal Head Thrust (hHT) (or “head impulse test”)  implies stroke [click for description]
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