Does intracerebral haemorrhage mimic benign dizziness presentations? A population based study.
OBJECTIVE
A principal reason to order a head CT scan for dizziness patients is to exclude stroke. As CT imaging is substantially limited in assessing for any acute lesions other than haemorrhage, the most important stroke syndrome adequately evaluated by CT is intracerebral haemorrhage (ICH). A population based stroke database was used to assess the frequency with which ICH might mimic a benign dizziness presentation.


METHODS
The Brain Attack Surveillance in Corpus Christi project was used to identify cases of ICH from 1 January 2000 to 26 December 2007. The hospital records of ICH cases with a National Institutes of Health Stroke Scale of <2 were abstracted for more detailed information. Cases were classified as benign dizziness presentations when isolated dizziness and a normal general neurological examination were documented.


RESULTS
Of 595 ICH cases, only 2.2% (13 of 595) had dizziness as the primary presenting symptom and a National Institutes of Health Stroke Scale of <2. No case mimicked a benign dizziness presentation. Only one case had isolated dizziness symptoms but this patient had dysmetria documented on the examination. All other cases had either focal or global neurological symptoms or examination abnormalities.


CONCLUSIONS
This study provides further support for the notion that ICH is highly unlikely to mimic a benign dizziness presentation. Coupled with the limitations of CT to show acute ischaemia in the posterior fossa, these results suggest that screening for ICH may not be necessary in benign appearing dizziness presentations although more research is needed.
Department of Neurology, University of Michigan Health Systems, Ann Arbor, MI 48109, USA. kakerber@umich.edu
Kevin A
KA
Kerber
James F
JF
Burke
Devin L
DL
Brown
William J
WJ
Meurer
Melinda A
MA
Smith
Lynda D
LD
Lisabeth
Lewis B
LB
Morgenstern
Darin B
DB
Zahuranec
D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging; D004244:Dizziness / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications*; D014057:Tomography, X-Ray Computed
Am J Epidemiol. 2004 Aug 15;160(4):376-83
15286023
J Gen Intern Med. 2008 Dec;23(12):2087-94
18843523
Acad Emerg Med. 2009 Oct;16(10):970-7
19799573
Stroke. 2009 Nov;40(11):3504-10
19762709
Acad Emerg Med. 2007 Nov;14(11):1015-22
17967964
JAMA. 2000 Jul 5;284(1):79-84
10872017
Stroke. 2001 Jun;32(6):1360-4
11387499
Acad Emerg Med. 2006 Mar;13(3):345-8
16495418
Am J Epidemiol. 2002 Dec 1;156(11):1062-9
12446264
BMJ. 1989 Aug 5;299(6695):349-55
2506965
Lancet. 2007 Jan 27;369(9558):293-8
17258669
Acad Emerg Med. 2008 Feb;15(2):177-82
18275448
Stroke. 2007 Dec;38(12):3213-7
17962593
Stroke. 2006 Oct;37(10):2484-7
16946161
Med Care. 1998 Jun;36(6):851-67
9630127
Ann Intern Med. 1994 May 15;120(10):856-71
7818632
Mayo Clin Proc. 2007 Nov;82(11):1329-40
17976352
Am Heart J. 1984 Jul;108(1):150-8
6731265
Ethn Dis. 2004 Autumn;14(4):520-6
15724771
Acad Emerg Med. 2008 Aug;15(8):744-50
18638027
Stroke. 2000 Apr;31(4):858-62
10753988
Emerg Med J. 2005 Apr;22(4):312
15788853
J Neurol Neurosurg Psychiatry. 2008 Apr;79(4):458-60
18344397
Emerg Med J. 2010 Jul;27(7):517-21
20584952