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Acute vestibular syndrome accompanying middle cerebral artery infarctions: a single-center study

Year 2024, EARLY ONLINE, 1 - 6
https://doi.org/10.18621/eurj.1501768

Abstract

Objectives: Acute vestibular syndrome (AVS) is a disease and disorder usually manifest with a single episode of sudden onset vestibular symptoms and signs, and may occur at any point along the vestibular pathway from the peripheral labyrinth to the vestibular cortex. This study presents the characteristics of the involved cortical area and clinical course in middle cerebral artery (MCA) territory infarction patients with central vestibular disorder.

Methods: Files of patients diagnosed with acute ischemic stroke in the MCA territory were reviewed retrospectively between December 2020 and March 2022. All the patients were categorized into two groups (with or without AVS) and analyzed for comorbidities as well as smoking and drinking habits, and their data pertaining to the neurological examination, bedside neuro-otological examination, and laboratory and computerized tomography angiography findings were collected.

Results: Seven hundred and sixty-eight patients with MCA territory infarction were included in the study. AVS incidence was calculated to be 13.3%. There was no statistically significant difference in the distribution of age and sex between patients with and without AVS. The involvement of the right side was significantly more prevalent in AVS patients. Distribution of patients with right-sided infarction: 11 with posterior superior temporal gyrus 17 with parieto-insular cortex, 16 with insular cortex and temporoparietal junction together, and 18 with more than one millimetric infarction in all three areas.

Conclusions: Patients with acute vestibular syndrome, may have infarctions in the anterior circulation and most of them had no pathological neuro-otologic test findings.

Ethical Statement

The Ethics Committee of the Ümraniye Training and Research Hospital approved the present study with its letter of approval no. 112 of 28.03.2024.

Thanks

We thank Abdullah Karaakın from Beykent University for translating this study from Turkish into English.

References

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  • 3. Kolominsky-Rabas PL, Weber M, Gefeller O, Neundoerfer B, Heuschmann PU. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001;32(12):2735-2740. doi: 10.1161/hs1201.100209.
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  • 5. Chakor RT, Eklare N. Vertigo in cerebrovascular diseases. Int J Otorhinolaryngol Clin. 2012;4(1): 46-53. doi: 10.5005/jp-journals-10003-1087
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  • 9. Pfeiffer C, Serino A, Blanke O. The vestibular system: a spatial reference for bodily self-consciousness. Front Integr Neurosci. 2014;8:31. doi: 10.3389/fnint.2014.00031.
  • 10. Kuwabara J, Kondo M, Kabaya K, et al. Acceptance and commitment therapy combined with vestibular rehabilitation for persistent postural-perceptual dizziness: A pilot study. Am J Otolaryngol. 2020;41(6):102609. doi: 10.1016/j.amjoto.2020.102609.
  • 11. Bisdorff AR, Staab JP, Newman-Toker DE. Overview of the International Classification of Vestibular Disorders. Neurol Clin. 2015;33(3):541-550, vii. doi: 10.1016/j.ncl.2015.04.010.
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  • 13. Choi JH, Park MG, Choi SY, et al. Acute Transient Vestibular Syndrome: Prevalence of Stroke and Efficacy of Bedside Evaluation. Stroke. 2017;48(3):556-562. doi: 10.1161/STROKEAHA.116.015507.
  • 14. Yeo SS, Jang SH, Kwon JW. Central vestibular disorder due to ischemic injury on the parieto-insular vestibular cortex in patients with middle cerebral artery territory infarction: Observational study. Medicine (Baltimore). 2017;96(51):e9349. doi: 10.1097/MD.0000000000009349.
  • 15. Zhou Y, Lee S-H, Mantokoudis G, et al. Vertigo and Dizziness in Anterior Circulation Cerebrovascular Disease: A Systematic Review (P3. 092). Neurology. 2014;82(10_supplement). doi:10.1212/WNL.82.10_supplement.P3.092.
  • 16. Dieterich M, Brandt T. Why acute unilateral vestibular cortex lesions mostly manifest without vertigo. Neurology. 2015;84(16):1680-1684. doi: 10.1212/WNL.0000000000001501.
  • 17. Lee SH, Jang MU, Kim Y, et al. Effect of Prestroke Glycemic Variability Estimated Glycated Albumin on Stroke Severity and Infarct Volume in Diabetic Patients Presenting With Acute Ischemic Stroke. Front Endocrinol (Lausanne). 2020;11:230. doi: 10.3389/fendo.2020.00230.
  • 18. Soliman RH, Oraby MI, Fathy M, Essam AM. Risk factors of acute ischemic stroke in patients presented to Beni-Suef University Hospital: prevalence and relation to stroke severity at presentation. Egypt J Neurol Psychiatr Neurosurg. 2018;54(1):8. doi: 10.1186/s41983-018-0012-4.
  • 19. Choi JH, Kim HW, Choi KD, et al. Isolated vestibular syndrome in posterior circulation stroke: Frequency and involved structures. Neurol Clin Pract. 2014;4(5):410-418. doi: 10.1212/CPJ.0000000000000028.
  • 20. Eguchi S, Hirose G, Miaki M. Vestibular symptoms in acute hemispheric strokes. J Neurol. 2019;266(8):1852-1858. doi: 10.1007/s00415-019-09342-9.
  • 21. Di Stefano V, De Angelis MV, Montemitro C, et al. Clinical presentation of strokes confined to the insula: a systematic review of literature. Neurol Sci. 2021;42(5):1697-1704. doi: 10.1007/s10072-021-05109-1.
Year 2024, EARLY ONLINE, 1 - 6
https://doi.org/10.18621/eurj.1501768

Abstract

References

  • 1. Tong D, Chen X, Wang Y, Wang Y, Du L, Bao J. Acute and episodic vestibular syndromes caused by ischemic stroke: predilection sites and risk factors. J Int Med Res. 2020;48(4):300060520918039. doi: 10.1177/0300060520918039.
  • 2. Grysiewicz RA, Thomas K, Pandey DK. Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors. Neurol Clin. 2008;26(4):871-895, vii. doi: 10.1016/j.ncl.2008.07.003.
  • 3. Kolominsky-Rabas PL, Weber M, Gefeller O, Neundoerfer B, Heuschmann PU. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001;32(12):2735-2740. doi: 10.1161/hs1201.100209.
  • 4. Kerber KA, Brown DL, Lisabeth LD, Smith MA, Morgenstern LB. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke. 2006;37(10):2484-2487. doi: 10.1161/01.STR.0000240329.48263.0d.
  • 5. Chakor RT, Eklare N. Vertigo in cerebrovascular diseases. Int J Otorhinolaryngol Clin. 2012;4(1): 46-53. doi: 10.5005/jp-journals-10003-1087
  • 6. Hashimoto T, Taoka M, Obayashi S, Hara Y, Tanaka M, Iriki A. Modulation of cortical vestibular processing by somatosensory inputs in the posterior insula. Brain Inj. 2013;27(13-14):1685-1691. doi: 10.3109/02699052.2013.831128.
  • 7. Lopez C, Blanke O, Mast FW. The human vestibular cortex revealed by coordinate-based activation likelihood estimation meta-analysis. Neuroscience. 2012;212:159-179. doi: 10.1016/j.neuroscience.2012.03.028.
  • 8. Choi KD, Kim JS. Vascular vertigo: updates. J Neurol. 2019;266(8):1835-1843. doi: 10.1007/s00415-018-9040-3.
  • 9. Pfeiffer C, Serino A, Blanke O. The vestibular system: a spatial reference for bodily self-consciousness. Front Integr Neurosci. 2014;8:31. doi: 10.3389/fnint.2014.00031.
  • 10. Kuwabara J, Kondo M, Kabaya K, et al. Acceptance and commitment therapy combined with vestibular rehabilitation for persistent postural-perceptual dizziness: A pilot study. Am J Otolaryngol. 2020;41(6):102609. doi: 10.1016/j.amjoto.2020.102609.
  • 11. Bisdorff AR, Staab JP, Newman-Toker DE. Overview of the International Classification of Vestibular Disorders. Neurol Clin. 2015;33(3):541-550, vii. doi: 10.1016/j.ncl.2015.04.010.
  • 12. Okroglic S, Widmann CN, Urbach H, Scheltens P, Heneka MT. Clinical symptoms and risk factors in cerebral microangiopathy patients. PLoS One. 2013;8(2):e53455. doi: 10.1371/journal.pone.0053455.
  • 13. Choi JH, Park MG, Choi SY, et al. Acute Transient Vestibular Syndrome: Prevalence of Stroke and Efficacy of Bedside Evaluation. Stroke. 2017;48(3):556-562. doi: 10.1161/STROKEAHA.116.015507.
  • 14. Yeo SS, Jang SH, Kwon JW. Central vestibular disorder due to ischemic injury on the parieto-insular vestibular cortex in patients with middle cerebral artery territory infarction: Observational study. Medicine (Baltimore). 2017;96(51):e9349. doi: 10.1097/MD.0000000000009349.
  • 15. Zhou Y, Lee S-H, Mantokoudis G, et al. Vertigo and Dizziness in Anterior Circulation Cerebrovascular Disease: A Systematic Review (P3. 092). Neurology. 2014;82(10_supplement). doi:10.1212/WNL.82.10_supplement.P3.092.
  • 16. Dieterich M, Brandt T. Why acute unilateral vestibular cortex lesions mostly manifest without vertigo. Neurology. 2015;84(16):1680-1684. doi: 10.1212/WNL.0000000000001501.
  • 17. Lee SH, Jang MU, Kim Y, et al. Effect of Prestroke Glycemic Variability Estimated Glycated Albumin on Stroke Severity and Infarct Volume in Diabetic Patients Presenting With Acute Ischemic Stroke. Front Endocrinol (Lausanne). 2020;11:230. doi: 10.3389/fendo.2020.00230.
  • 18. Soliman RH, Oraby MI, Fathy M, Essam AM. Risk factors of acute ischemic stroke in patients presented to Beni-Suef University Hospital: prevalence and relation to stroke severity at presentation. Egypt J Neurol Psychiatr Neurosurg. 2018;54(1):8. doi: 10.1186/s41983-018-0012-4.
  • 19. Choi JH, Kim HW, Choi KD, et al. Isolated vestibular syndrome in posterior circulation stroke: Frequency and involved structures. Neurol Clin Pract. 2014;4(5):410-418. doi: 10.1212/CPJ.0000000000000028.
  • 20. Eguchi S, Hirose G, Miaki M. Vestibular symptoms in acute hemispheric strokes. J Neurol. 2019;266(8):1852-1858. doi: 10.1007/s00415-019-09342-9.
  • 21. Di Stefano V, De Angelis MV, Montemitro C, et al. Clinical presentation of strokes confined to the insula: a systematic review of literature. Neurol Sci. 2021;42(5):1697-1704. doi: 10.1007/s10072-021-05109-1.
There are 21 citations in total.

Details

Primary Language English
Subjects Central Nervous System
Journal Section Original Articles
Authors

Nevin Kuloğlu Pazarcı 0000-0002-3004-3031

Gizem Gürsoy 0000-0003-4448-5962

Necip Kürşad Çiftçi 0009-0009-4013-8171

Early Pub Date October 11, 2024
Publication Date
Submission Date July 11, 2024
Acceptance Date October 2, 2024
Published in Issue Year 2024 EARLY ONLINE

Cite

AMA Kuloğlu Pazarcı N, Gürsoy G, Çiftçi NK. Acute vestibular syndrome accompanying middle cerebral artery infarctions: a single-center study. Eur Res J. Published online October 1, 2024:1-6. doi:10.18621/eurj.1501768

e-ISSN: 2149-3189 


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