Does intracerebral haemorrhage mimic benign dizziness presentations? A population based study

Kevin A Kerber, James F Burke, Devin L Brown, William J Meurer, Melinda A Smith, Lynda D Lisabeth, Lewis B Morgenstern, Darin B Zahuranec
Emergency Medicine Journal: EMJ 2012, 29 (1): 43-6

OBJECTIVE: A principal reason to order a head CT scan for dizziness patients is to exclude stroke. As CT imaging is substantially limited in assessing for any acute lesions other than haemorrhage, the most important stroke syndrome adequately evaluated by CT is intracerebral haemorrhage (ICH). A population based stroke database was used to assess the frequency with which ICH might mimic a benign dizziness presentation.

METHODS: The Brain Attack Surveillance in Corpus Christi project was used to identify cases of ICH from 1 January 2000 to 26 December 2007. The hospital records of ICH cases with a National Institutes of Health Stroke Scale of <2 were abstracted for more detailed information. Cases were classified as benign dizziness presentations when isolated dizziness and a normal general neurological examination were documented.

RESULTS: Of 595 ICH cases, only 2.2% (13 of 595) had dizziness as the primary presenting symptom and a National Institutes of Health Stroke Scale of <2. No case mimicked a benign dizziness presentation. Only one case had isolated dizziness symptoms but this patient had dysmetria documented on the examination. All other cases had either focal or global neurological symptoms or examination abnormalities.

CONCLUSIONS: This study provides further support for the notion that ICH is highly unlikely to mimic a benign dizziness presentation. Coupled with the limitations of CT to show acute ischaemia in the posterior fossa, these results suggest that screening for ICH may not be necessary in benign appearing dizziness presentations although more research is needed.

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