title: Long-term prognosis of patients presenting first-ever vestibular symptoms in a community-based study.
abstract: BACKGROUND
  Vestibular symptoms (VSs) are frequent complaints in patients attending ambulatory care and the emergency room. They may represent a peripheral vestibular disorder or a stroke/transient ischemic attack (TIA), yet many patients have VSs that cannot be clearly classified at presentation. This study aims to characterize and determine the long-term prognosis of these patients.
  
  
  METHODS
  In a prospective community-based study involving 104,700 individuals registered at 4 health centers of Northern Portugal, patients with a first-ever-in-lifetime focal neurologic symptom (FNS) were ascertained using comprehensive methods, including referrals from physicians working in the study area and data retrieved from emergency/discharge records. Physicians were encouraged to report/notify any patient who might have experienced an FNS, including those with vertigo or vertigo-like symptoms, imbalance, presyncope, or nonspecific dizziness. After neurologic assessment patients were classified as having a peripheral vestibular symptom (pVS), a stroke/TIA, or an unclassified vestibular symptom (uVS). They were followed up 7 years after the index event at the outpatient clinic; predictors of survival free from stroke or vascular events were determined using Cox proportional hazards models.
  
  
  RESULTS
  Of the 1163 patients with an FNS, 360 (31.0%) were included, 16.7% had a stroke/TIA, 57.8% had pVS, and 25.6% had uVS. Most patients presented only isolated VSs (62.8%); 63% were women and mean age was 60.1 years (standard deviation = 16); hypertension (47.8%), hypercholesterolemia (41.9%), and diabetes (19.2%) were the most prevalent vascular risk factors (VRFs). Cranial computed tomography (CT) scan was performed in 63.3%. Adjusting for age, sex, VRFs, and diagnosis (TIA, pVS and uVS), the long-term risk of stroke was higher when CT showed silent infarctions (hazard rate [HR] = 3.96; 95% confidence interval [CI], 1.63-9.60) and the risk of vascular events (stroke, myocardial infarction, or vascular death) was higher in patients with 2 or more VRFs (HR = 2.70; 95% CI, 1.25-5.86). Identical results were obtained when restricting the model to patients with pVS or uVS.
  
  
  CONCLUSIONS
  First-ever-in-lifetime VSs are common in patients with FNS and may represent a good opportunity for preventing a serious vascular event, particularly in patients with vascular comorbidity (silent infarctions and VRFs).
authors.affiliation: Serviço de Neurologia, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal. Electronic address: rjrfelgueiras@gmail.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Felgueiras
authors.affiliation: Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Magalhães
authors.affiliation: Serviço de Neurologia, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal; Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.
authors.forename: Manuel
authors.initials: M
authors.lastname: Correia
authors.affiliation: Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.
authors.forename: Maria Carolina
authors.initials: MC
authors.lastname: Silva
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004244:Dizziness / Q000453:epidemiology / Q000503:physiopathology; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010045:Outpatients; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D014717:Vertigo / Q000453:epidemiology / Q000503:physiopathology; D015837:Vestibular Diseases / Q000145:classification / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology*
keywords: Vestibular symptoms; brain imaging; community-based study; long-term prognosis; vascular risk factors