The Prevalence Of Stroke In Acute Vertigo Presentations In Erbil East Emergency Hospital

Abstract

Background: Vertigo is a common symptom in emergency departments (EDs), with both peripheral and central causes. Central vertigo, particularly ischemic strokes, can initially present with isolated vertigo symptoms, posing a diagnostic challenge. Timely identification of stroke-related vertigo is crucial to initiate appropriate treatment and improve patient outcomes. This study aims to determine the prevalence of acute ischemic brain injury among patients with acute vertigo, using advanced neuroimaging techniques, including diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) MRI.

Objective: The aim of this study is to determine how frequently ischemic brain injury occurs among acute vertigo patients visiting Erbil East Emergency Hospital.

Methods: A cross-sectional study was conducted at Erbil East Emergency Hospital from May 2, 2024, to April 1, 2025. A total of 144 patients presenting with acute vertigo were screened for ischemic brain injury using DWI-MRI within 5 hours of symptom onset. Positive cases were followed up with FLAIR-MRI after 24 hours to differentiate between ischemic stroke and transient ischemic attack (TIA). A total of 23 patients were diagnosed with ischemic brain injury and formed the acute ischemic brain injury sub-cohort.

Results: Among the 23 patients in the sub-cohort, 14 (61%) were diagnosed with ischemic stroke and 9 (39%) with TIA. Of the ischemic stroke cases, 93% were associated with posterior circulation lesions, while 7% involved anterior circulation lesions. Of the TIA cases, 77.7% had posterior circulation involvement, and 22.2% had anterior circulation lesions. MRI findings revealed persistent lesions on FLAIR imaging in ischemic stroke cases, while TIA lesions resolved, confirming the transient nature of the event.

Conclusion: This study highlights the significant prevalence of ischemic brain injury, particularly posterior circulation strokes, among patients presenting with acute vertigo. The use of DWI and FLAIR MRI offers critical diagnostic accuracy in distinguishing ischemic stroke from TIA and peripheral causes of vertigo. Early and accurate identification of ischemic brain injury is crucial for appropriate management and timely interventions.