Association between clinical and imaging features and 3-month prognosis of patients with acute dizziness_West China Medical Journal

Authors：

HUA Xing ^1,2 , CHENG Xi ³ , WANG Yanan ^1,2 , LIU Meng ^1,2 , HUANG Linrui ^1,2 ,  WU Simiao ^1,2

1. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

WU Simiao, Email: simiao.wu@hotmail.com

Keywords：

Dizziness; clinical features; imaging features; recurrence; stroke

DOI：

10.7507/1002-0179.202401243

Video：

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Objective To explore the clinical and imaging features of patients with acute dizziness and assess their associations with 3-month prognosis. Methods We enrolled adult patients with a chief complaint of acute dizziness, who were admitted to the Neurological Clinic at the Emergency Department of West China Hospital, Sichuan University between January 1st and May 31st 2022. We collected clinical and imaging features at baseline for each patient. The primary outcome was recurrent dizziness within 3 months after index dizziness. Secondary outcome was stroke within 3 months after index dizziness. Results A total of 1 322 patients who visited the Neurological Clinic were included, of which 617 (46.7%) had a chief complaint of acute dizziness. Among 222 patients who performed emergent brain and neck CT angiography, 1 patient presented with intracerebral haemorrhage. Among the remaining 221 patients, 206 patients completed 3-month follow-up, with 76 patients reported recurrent dizziness and 7 patients had stroke (6 ischaemic, 1 hemorrhagic). The multivariate logistic regression showed that chronic dizziness duration and parenchymal hypodensity on brain CT were each associated with a higher risk of recurrent dizziness. Compared with those who did not report stroke, the stroke patients were more likely to present with hypertension, headache symptoms, and exhibit parenchymal hypodensity on baseline CT (P<0.05). Conclusions In patients with acute dizziness, those with chronic dizziness duration and parenchymal hypodensity on baseline CT were associated with a higher risk of 3-month recurrent dizziness. Acute dizziness patients experiencing 3-month stroke often have hypertension, headache symptoms, and parenchymal hypodensity on baseline CT.

Citation： HUA Xing, CHENG Xi, WANG Yanan, LIU Meng, HUANG Linrui, WU Simiao. Association between clinical and imaging features and 3-month prognosis of patients with acute dizziness. West China Medical Journal, 2024, 39(4): 588-593. doi: 10.7507/1002-0179.202401243 Copy

1.	中華醫學會神經病學分會, 中華神經科雜志編輯委員會. 眩暈診治多學科專家共識. 中華神經科雜志, 2017, 50(11): 805-812.
2.	Bittar RS, Oiticica J, Bottino MA, et al. Population epidemiological study on the prevalence of dizziness in the city of S?o Paulo J. Braz J Otorhinolaryngol, 2013, 79(6): 688-698.
3.	Wiltink J, Tschan R, Michal M, et al. Dizziness: anxiety, health care utilization and health behavior--results from a representative German community survey. J Psychosom Res, 2009, 66(5): 417-424.
4.	中華醫學會, 中華醫學會雜志社, 中華醫學會全科醫學分會, 等. 頭暈/眩暈基層診療指南(2019 年). 中華全科醫師雜志, 2020, 19(3): 201-216.
5.	Zwergal A, Dieterich M. Vertigo and dizziness in the emergency room. Curr Opin Neurol, 2020, 33(1): 117-125.
6.	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(10): 2484-2487.
7.	Wang J, Zhu S, Xu P, et al. Initial symptoms of vertebrobasilar artery occlusions and the outcomes after endovascular treatment. J Neurol, 2022, 269(10): 5561-5570.
8.	Guarnizo A, Farah K, Lelli DA, et al. Limited usefulness of routine head and neck CT angiogram in the imaging assessment of dizziness in the emergency department. Neuroradiol J, 2021, 34(4): 335-340.
9.	Expert Panel on Neurologic Imaging; Sharma A, Kirsch CFE, et al. ACR appropriateness criteria^? hearing loss and/or vertigo. J Am Coll Radiol, 2018, 15(11S): S321-S331.
10.	ElHabr A, Merdan S, Ayer T, et al. Increasing utilization of emergency department neuroimaging from 2007 through 2017. AJR Am J Roentgenol, 2022, 218(1): 165-173.
11.	Caplan LR. Dizziness: how do patients describe dizziness and how do emergency physicians use these descriptions for diagnosis?. Mayo Clin Proc, 2007, 82(11): 1313-1315.
12.	Bronstein AM, Lempert T, Seemungal BM. Chronic dizziness: a practical approach. Pract Neurol, 2010, 10(3): 129-139.
13.	Staibano P, Lelli D, Tse D. A retrospective analysis of two tertiary care dizziness clinics: a multidisciplinary chronic dizziness clinic and an acute dizziness clinic. J Otolaryngol Head Neck Surg, 2019, 48(1): 11.
14.	Fox AJ. How to measure carotid stenosis. Radiology, 1993, 186(2): 316-318.
15.	Aho K, Harmsen P, Hatano S, et al. Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ, 1980, 58(1): 113-130.
16.	Li Q, Yang Y, Reis C, et al. Cerebral small vessel disease. Cell Transplant, 2018, 27(12): 1711-1722.
17.	Bao X, Tan JW, Long Y, et al. Effect of intermittent hypoxia training for dizziness: a randomized controlled trial. J Sport Rehabil, 2019, 28(6): 540-543.
18.	Kaski D, Rust HM, Ibitoye R, et al. Theoretical framework for “unexplained” dizziness in the elderly: the role of small vessel disease. Prog Brain Res, 2019, 248: 225-240.
19.	Cha YH. Chronic Dizziness. Continuum (Minneap Minn), 2021, 27(2): 420-446.
20.	Lahmann C, Henningsen P, Brandt T, et al. Psychiatric comorbidity and psychosocial impairment among patients with vertigo and dizziness. J Neurol Neurosurg Psychiatry, 2015, 86(3): 302-308.
21.	Stubberud A, Buse DC, Kristoffersen ES, et al. Is there a causal relationship between stress and migraine? Current evidence and implications for management. J Headache Pain, 2021, 22(1): 155.
22.	von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry, 2007, 78(7): 710-715.
23.	Lee SH, Kim JS. Benign paroxysmal positional vertigo. J Clin Neurol, 2010, 6(2): 51-63.
24.	Khalil RA. Estrogen, vascular estrogen receptor and hormone therapy in postmenopausal vascular disease. Biochem Pharmacol, 2013, 86(12): 1627-1642.
25.	Dubey N, Bakshi R, Wasay M, et al. Early computed tomography hypodensity predicts hemorrhage after intravenous tissue plasminogen activator in acute ischemic stroke. J Neuroimaging, 2001, 11(2): 184-188.
26.	Leira R, Dávalos A, Aneiros A, et al. Headache as a surrogate marker of the molecular mechanisms implicated in progressing stroke. Cephalalgia, 2002, 22(4): 303-308.

1. 中華醫學會神經病學分會, 中華神經科雜志編輯委員會. 眩暈診治多學科專家共識. 中華神經科雜志, 2017, 50(11): 805-812.
2. Bittar RS, Oiticica J, Bottino MA, et al. Population epidemiological study on the prevalence of dizziness in the city of S?o Paulo J. Braz J Otorhinolaryngol, 2013, 79(6): 688-698.
3. Wiltink J, Tschan R, Michal M, et al. Dizziness: anxiety, health care utilization and health behavior--results from a representative German community survey. J Psychosom Res, 2009, 66(5): 417-424.
4. 中華醫學會, 中華醫學會雜志社, 中華醫學會全科醫學分會, 等. 頭暈/眩暈基層診療指南(2019 年). 中華全科醫師雜志, 2020, 19(3): 201-216.
5. Zwergal A, Dieterich M. Vertigo and dizziness in the emergency room. Curr Opin Neurol, 2020, 33(1): 117-125.
6. 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(10): 2484-2487.
7. Wang J, Zhu S, Xu P, et al. Initial symptoms of vertebrobasilar artery occlusions and the outcomes after endovascular treatment. J Neurol, 2022, 269(10): 5561-5570.
8. Guarnizo A, Farah K, Lelli DA, et al. Limited usefulness of routine head and neck CT angiogram in the imaging assessment of dizziness in the emergency department. Neuroradiol J, 2021, 34(4): 335-340.
9. Expert Panel on Neurologic Imaging; Sharma A, Kirsch CFE, et al. ACR appropriateness criteria^? hearing loss and/or vertigo. J Am Coll Radiol, 2018, 15(11S): S321-S331.
10. ElHabr A, Merdan S, Ayer T, et al. Increasing utilization of emergency department neuroimaging from 2007 through 2017. AJR Am J Roentgenol, 2022, 218(1): 165-173.
11. Caplan LR. Dizziness: how do patients describe dizziness and how do emergency physicians use these descriptions for diagnosis?. Mayo Clin Proc, 2007, 82(11): 1313-1315.
12. Bronstein AM, Lempert T, Seemungal BM. Chronic dizziness: a practical approach. Pract Neurol, 2010, 10(3): 129-139.
13. Staibano P, Lelli D, Tse D. A retrospective analysis of two tertiary care dizziness clinics: a multidisciplinary chronic dizziness clinic and an acute dizziness clinic. J Otolaryngol Head Neck Surg, 2019, 48(1): 11.
14. Fox AJ. How to measure carotid stenosis. Radiology, 1993, 186(2): 316-318.
15. Aho K, Harmsen P, Hatano S, et al. Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ, 1980, 58(1): 113-130.
16. Li Q, Yang Y, Reis C, et al. Cerebral small vessel disease. Cell Transplant, 2018, 27(12): 1711-1722.
17. Bao X, Tan JW, Long Y, et al. Effect of intermittent hypoxia training for dizziness: a randomized controlled trial. J Sport Rehabil, 2019, 28(6): 540-543.
18. Kaski D, Rust HM, Ibitoye R, et al. Theoretical framework for “unexplained” dizziness in the elderly: the role of small vessel disease. Prog Brain Res, 2019, 248: 225-240.
19. Cha YH. Chronic Dizziness. Continuum (Minneap Minn), 2021, 27(2): 420-446.
20. Lahmann C, Henningsen P, Brandt T, et al. Psychiatric comorbidity and psychosocial impairment among patients with vertigo and dizziness. J Neurol Neurosurg Psychiatry, 2015, 86(3): 302-308.
21. Stubberud A, Buse DC, Kristoffersen ES, et al. Is there a causal relationship between stress and migraine? Current evidence and implications for management. J Headache Pain, 2021, 22(1): 155.
22. von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry, 2007, 78(7): 710-715.
23. Lee SH, Kim JS. Benign paroxysmal positional vertigo. J Clin Neurol, 2010, 6(2): 51-63.
24. Khalil RA. Estrogen, vascular estrogen receptor and hormone therapy in postmenopausal vascular disease. Biochem Pharmacol, 2013, 86(12): 1627-1642.
25. Dubey N, Bakshi R, Wasay M, et al. Early computed tomography hypodensity predicts hemorrhage after intravenous tissue plasminogen activator in acute ischemic stroke. J Neuroimaging, 2001, 11(2): 184-188.
26. Leira R, Dávalos A, Aneiros A, et al. Headache as a surrogate marker of the molecular mechanisms implicated in progressing stroke. Cephalalgia, 2002, 22(4): 303-308.

West China Medical Journal

Association between clinical and imaging features and 3-month prognosis of patients with acute dizziness

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