JBBS> Vol.2 No.1, February 2012

Treatment Efficacy in Vertebrobasilar Transient Ischemic Attacks Presenting as Isolated Vertigo: A Retrospective Case Study

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Lea Pollak

ABSTRACT

Background: Vertigo without other neurological symptoms is usually not supposed to be due to a vascular cause. How-ever, hypoperfusion of the anterior cerebellar artery can lead to ischemia of the vestibular labyrinth and/or vestibular nuclei in the pontomedullary region whereas hypoperfusion of the posterior cerebellar artery can cause ischemia of the vestibulocerebellum, all resulting in isolated vertigo. Methods: We retrospectively reviewed the clinical records of pa-tients with vertebrobasilar ischemic attacks referred to our outpatient dizziness clinic during the years 1999-2009. Pa-tients who presented only with vertigo (+/– vomiting and unsteadiness) were selected. Their clinical data, findings and treatment responses were recorded. Results: Amongst about one hundred patients with vertebrobasilar TIA we found 24 patients with monosymptomatic presentation. Their mean age was 67.3 years, fifteen were men. In most of the patients the vertigo attacsk were multiple and lasted from minutes to hours. All but four patients had at least one vascular risk factor at the time of presentation ,among them 13 had multiple vascular risk factors. Seven patients had evidence of chronic ischemic changes on brain CT or MRI .Aspirin (100 - 325 mg/die) was started in 15 patients. Three patients were started on clopidogrel (75 mg/die) because of aspirin intolerance and two patients on warfarin due to atrial fibrilla-tion. In two patients who were treated with aspirin prior to their vertigo attack, clopidogrel or dipyridamol were added. The mean time period from first attack to treatment initiation was 5.2 months. The mean follow up period was 27.4 months. In 18 patients the attacks have completely resolved after treatment initiation. Three patients had further vertigo attacks despite treatment. Two patients with vertigo episodes where a vascular etiology was not suspected, developed later an ischemic stroke in the vertebrobasilar territory (anterior cerebellar artery and vertebral artery infarct). Conclusions: The differential diagnosis of a vertigo attack presenting in a monosymptomatic form should include vertebrobasilar TIA, especially in individuals with vascular risk factors. In view of lack of a specific test for establishing the diagnosis antiplatelets should be administered on empirical grounds since early administration of therapy can abolish further attacks and prevent a vertebrobasilar stroke. Warfarin should be preserved for patients with cardiac conditions that warrant antiocoagulation for stroke prevention.

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L. Pollak, "Treatment Efficacy in Vertebrobasilar Transient Ischemic Attacks Presenting as Isolated Vertigo: A Retrospective Case Study," Journal of Behavioral and Brain Science, Vol. 2 No. 1, 2012, pp. 92-96. doi: 10.4236/jbbs.2012.21010.

References

[1] R. W. Baloh, “Vertebrobasilar Insufficiency and Stroke,” Otolaryngology Head and Neck Surgery, Vol. 112, No. 1, 1995, pp. 114-117. doi:10.1016/S0194-5998(95)70309-8
[2] C. M. Fisher, “Vertigo in Cerebrovascular Diseases,” Archives of Otolaryngology Head Neck Surgery, Vol. 85, No. 5, 1947, pp. 529-534. doi:10.1001/archotol.1967.00760040531010
[3] A. Grad and R. W. Baloh, “Vertigo of Vascular Origin. Clinical and Electronystagmographic Features in 84 Cases,” Archives of Neurology, Vol. 46, No. 3, 1989, pp. 281-284.
[4] J. G. Oas and R. W. Baloh, “Vertigo and the Anterior Inferior Cerebellar Artery Syndrome,” Neurology, Vol. 42, No. 2, 1992, pp. 2274-2279.
[5] C. R. Gomez, S. Cruz-Flores, M. D. Malkoff, C. M. Sauer and C. M. Burch, “Isolated Vertigo as a Manifestation of Vertebrobasilar Ischemia,” Neurology, Vol. 47, No. 1, 1996, pp. 94-97.
[6] C. Y. Huang and Y. L. Yu, “Small Cerebellar Strokes May Mimic Labyrinthine Lesions,” Journal of Neurology, Neurosurgery & Psychiatry, 1985, 48: Vol. 48, No. 3, 1985, pp. 263-265. doi:10.1136/jnnp.48.3.263
[7] T. D. Fife, R. W. Baloh and G. R. Duckwiler, “Isolated Dizziness in Vertebrobasilar Insufficiency: Clinical Features, Angiography, and Follow-Up,” Journal of Stroke and Cerebrovascular Diseases, Vol. 4, No. 1, 1991, pp. 4-12. doi:10.1016/S1052-3057(10)80139-9
[8] G. W. Kim and J. H. Heo, “Vertigo of Cerebrovascular Origin Proven by CT Scan or MRI: Pitfalls in Clinical Differentiation from Vertigo of Aural Origin,” Yonsei Medical Journal, Vol. 37, No. 1, 1996, pp. 47-51.
[9] H. Lee, H. A. Yi, Y. W. Cho, C. H. Sohn, G. T. Whitman, S. Ying and R. W. Baloh, “Nodulus infarction Mimicking Acute Peripheral Vestibulopathy,” Neurology, Vol. 60, No. 10, 2003, pp. 1700-1702.
[10] M. Dieterich, “Vaskular Schwindel,” Der Nervenarzt, Vol. 73, No. 12, 2002, pp. 1133-1143. doi:10.1007/s00115-002-1454-5

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