Dizziness Evaluation and Characterisation of Patients with Posterior Circulation Stroke in the Emergency Department; a Case Series Study

Dizziness is a common scenario in the Emergency Departments (EDs). Among dizziness un-derlying causes, the posterior circulation stroke is especially relevant due to its mobimortality and concerningmisdiagnosis rates. Therefore, we conducted this study to assess dizziness evaluation and baseline characteris-tics of patients with PS in the ED.

We conducted a 3-year retrospective observational study on PS casesconfirmed by magnetic resonance imaging (MRI). Concretely, we analysed the demographic profile of these pa-tients, the initial PS clinical presentation, and diagnostic workup (with emphasis on dizziness evaluation) per-formed at the ED.

During the study period, 85 cases were registered. Risk factors for cardiovasculardisease were present in 85.5% and previous visits to the ED due to dizziness were recorded in 16.5%. The mainclinical presentation was dizziness, concretely as an acute vestibular syndrome (38.8%) with additional neuro-logical signs or symptoms (80%). Evaluation by the otolaryngologist on call was requested in less than 10% ofthe cases and included the HINTS protocol use with a sensitivity of 100% for central nervous system underlyingcausality. A brain CT study was always performed with a sensitivity of 27%. However, 96.47% of patients wereprimarily admitted to the Neurology hospitalization ward and MRI was always performed in a mean time of3.21 days confirming the diagnosis.

Dizziness is the most frequent symptom of PS. Patients usuallypresent an AVS (associated with additional N-SS or not) and HINTS bedside examination is the most adequateprotocol to differentiate a PS from other AVS causes until the diagnostic confirmation via MRI. Interestingly,mainly otolaryngologists seem to use HINTS. However, the use of CT is widespread despite its poor value.