title: Discrimination of acute ischemic stroke from nonischemic vertigo in patients presenting with only imbalance.
abstract: Some patients who present with an acute feeling of imbalance are experiencing an ischemic stroke that is not evident on computed tomography (CT) scans. The aim of this study was to compare ischemic stroke and nonischemic vertigo patient groups and to investigate independent factors associated with ischemic stroke. We examined 332 consecutive patients with an acute feeling of imbalance who showed no neurologic findings or responsible lesions on CT scan at the hyperacute phase. We examined their clinical backgrounds, physical findings, and laboratory examinations, with ischemic stroke diagnosed by later CT and/or magnetic resonance imaging (MRI). We identified 41 (12.3%) ischemic stroke patients. Atrial fibrillation (odds ratio 4.1; 95% confidence interval 1.4-11.5), white blood cell count (10(3)/μL, 1.4; 1.2-1.6), head and/or neck pain (4.6; 2.1-10.3), first attack of imbalance feeling (3.3; 1.1-12.2), and dizziness (3.7; 1.7-8.3) were significant and independent factors associated with ischemic stroke among patients with an acute feeling of imbalance. We used these factors to calculate an "imbalance score"; 1 point was given for the presence of each factor and a score of 3-5 points was independently associated with ischemic stroke. An awareness of these factors may indicate that further examinations including MRI are necessary to rule out ischemic stroke.
authors.affiliation: Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital; Department of Neurology, Faculty of Life Sciences, Kumamoto University. Electronic address: shoji-honda@fc.kuh.kumamoto-u.ac.jp.
authors.forename: Shoji
authors.initials: S
authors.lastname: Honda
authors.affiliation: Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Inatomi
authors.affiliation: Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Yonehara
authors.affiliation: Department of Neurology, Kumamoto City Hospital.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Department of Neurology, Faculty of Life Sciences, Kumamoto University.
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Hirano
authors.affiliation: Department of Neurology, Faculty of Life Sciences, Kumamoto University.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ando
authors.affiliation: Department of Neurology, Jonan Hospital, Kumamoto, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Uchino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D004856:Postural Balance; D011237:Predictive Value of Tests; D012307:Risk Factors; D012678:Sensation Disorders / Q000209:etiology* / Q000503:physiopathology; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D014717:Vertigo / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology
keywords: Ischemic stroke; cerebral infarction; emergency neurology; imbalance; vertigo