Clinical Features Differ Between Patients With Vertigo Attack Only and Weakness Attack Accompanying Vertigo Before Vertebrobasilar Stroke: A Retrospective Study

Abstract

Objective: To determine the different clinical features of patients with vertigo attacks alone and of those with weakness accompanying vertigo attacks before the vertebrobasilar ischemic stroke.

Methods: In this 4-year retrospective study, we manually screened the medical records of 209 patients, hospitalized with vertigo attack as the main complaint who were finally diagnosed with acute vertebrobasilar ischemic stroke. Patients were divided into two groups according to their symptoms: patients who only experienced vertigo attacks prior to the vertebrobasilar stroke (VO group) and patients who had both vertigo and weakness attacks (VW group) prior to the stroke. Clinical parameters, such as infarction site and volume, relative risk factors, ABCD² score, and medical intervention, were compared between the two groups.

Results: The prevalence of hypertension was higher in the Vertigo attacks only (VO) group (42.2 vs. 29.0%, p < 0.05). The total cerebral infarction volume in the VO group was larger than the Vertigo and weakness attacks (VW) group (4.44 vs. 2.12 cm³, p < 0.05). Additionally, the cerebellum was more likely to be affected in the VO group. In contrast, patients in the VW group had higher carotid stenosis (14.2 vs. 27.2%, p < 0.05) and ABCD² score (2.1 ± 1.2 vs. 3.6 ± 1.5, p = 0.02). The percentage of patients with medullary infarctions also increased in the VW group. Vertigo attack events occurred more frequently in the VW group (median 2.4 vs. 4.3, p < 0.04). We also found that the patients in the VW group were more likely to seek medical intervention after vertigo.

Conclusions: Clinical parameters, such as infarction location, relative risk factors, and ABCD² score, differed between patients with vertigo symptoms with or without weakness attacks. These findings highlight the different clinical features of patients with vertigo attack only and those with weakness attacks accompanying vertigo prior to vertebrobasilar ischemic stroke.

Keywords: cerebral infarction; infarction; vertebrobasilar stroke; vertigo attack; weakness attack.

Figure 1

Study flow chart, TIA, and transient ischemic attack.

Figure 2

Clinical parameter comparison between the vertebrobasilar stroke (VO) group and the vertigo and weakness attacks (VW group). (A) The prevalence of hypertension is increased in the VO group (42.2 vs. 29.0%, p < 0.05). However, patients in the VW group had higher extracranial stenosis (14.2 vs. 27.2%, p < 0.05). (B) The frequency of vertigo attacks is higher in the VW group (median 2.4 vs. 4.3, p < 0.04). (C) The mean interval (the period from the onset of the vertigo attack to the diagnosis of ischemic stroke) shows no differences between the VO group and the VW group (median 37.6 vs. 45.4 days, p = 0.08). (D) Patients in the VW group are more likely to seek the medical attention after the vertigo symptom occurred (29.2 vs. 45.4%, p < 0.03). (E) The cerebellum is more frequently inflicted in the VO group (44.1 vs. 21.8%, p < 0.001). However, the medullary is more likely to be inflicted in the VW group (29.2 vs. 43.6%; p = 0.02). (F) The infarction volume in VO group is larger than the VW group (4.44 vs. 2.12 cm³, p < 0.05). * and # represents p < 0.05, ns, no statistical difference.

Figure 3

The differences in the infarction location between the VO group and the VW group. (A–C) Magnetic resonance imaging (MRI) from the VW group. T2 sequence axial MRI displays a tiny amount of increased signal located in the right side of the lateral medullary pointed by the red arrow. Diffusion-weighted imaging (DWI) sequences confirm the ischemic event. (D–F) MRI images from the VO group. MRI scan indicates an acute infarct in the cerebellum pointed by the red arrow. T2 sequence axial MRI displays a hyperintense area located in the left side of cerebellum. The ischemic event is confirmed by the DWI sequences further.