Vertigo and Dizziness in Anterior Circulation Cerebrovascular Disease: A Systematic Review (P3.092)

OBJECTIVE: Determine the frequency and topography of vestibular symptoms in anterior circulation stroke and transient ischemic attack (TIA) by systematic review of the literature. BACKGROUND: Vertigo and dizziness are common posterior (vertebrobasilar) circulation stroke symptoms. Less is known about vestibular symptoms in anterior (carotid) circulation vascular disease. DESIGN/METHODS: Electronic (MEDLINE) and manual search for English-language studies (1966-2011) of vertigo, dizziness, or syncope due to anterior circulation stroke or TIA. Two independent reviewers selected studies, with differences adjudicated by a third. Study characteristics, patient symptoms, and lesion locations were abstracted. For each class of data, only unbiased studies were analyzed. We conducted image analysis of published radiographic lesions. RESULTS: We identified 522 unique citations, examined 110 full manuscripts, and analyzed 54 studies describing 2,114 patients with anterior circulation stroke or TIA and reporting vestibular symptoms. Principal reasons for abstract exclusion were non-English language, no confirmed cerebrovascular diagnosis, and not anterior circulation (73%). Principal reasons for manuscript exclusion were no reported dizziness and no confirmed cerebrovascular diagnosis (48%). Mean patient age was 67 years (range 9-99), with a male predominance (M:F ratio 2:1). The prevalence of vestibular symptoms in unbiased studies of anterior circulation stroke (n=1,643) was 11.3% (n=185). Vertigo was the most common dizziness type (35% vertigo, 15% non-vertiginous dizziness, 10% presyncope, 40% unspecified). TIAs were more common than ischemic stroke. Typical stroke locations were the insula, parietal cortex, and adjacent subcortical white matter, with a right-sided predominance (51% right vs. 35% left, 14% bilateral, p=0.0013). CONCLUSIONS: Vertigo and dizziness are not rare manifestations of carotid territory ischemia, particularly in the temporo-parietal regions. Although dizziness is generally more prevalent in women, anterior circulation stroke causing dizziness appears to be more prevalent in men. Clinicians should carefully consider a search for anterior circulation vascular disease in patients presenting with vestibular symptoms. Disclosure: Dr. Zhou has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Mantokoudis has nothing to disclose. Dr. Saber Tehrani has nothing to disclose. Dr. Ying has nothing to disclose. Dr. Kerber has received personal compensation for activities with Estes, Ingram, and Foels & Gibbs as a consultant, and with Janssen Pharmaceuticals as a speaker. Dr. Kerber has received royalty payments from Oxford University Press. Dr. Hsieh has nothing to disclose. Dr. Robinson has nothing to disclose. Dr. Hanley has received research support from the FDA Orphan Drug Program, Cathflo, and Genentech Inc. Dr. Zee has received personal compensation for activities with Sun Pharma and Abbott. Dr. Zee has received royalty payments from Oxford University Press. Dr. Newman-Toker has received personal compensation for activities with Janssen Pharmaceuticals. Dr. Newman-Toker has received compensation for serving on the board of Society to Improve Diagnosis in Medicine. Dr. Newman-Toker has received research support from GN Otometrics.