Objective:
Ischemic stroke can be a diagnostic dilemma in presentations of acute dizziness and increased resources will likely be required to reduce instances of misdiagnosis. To inform the potential value of the deployment of increased resources, we sought to describe opportunities for therapeutic interventions from a series of acute dizziness-stroke patients who had diagnostic uncertainty (i.e., only mild or no general neurologic deficits) on presentation.
Methods:
Active and passive surveillance methods were used at a tertiary care center to identify acute dizziness patients with nystagmus or imbalance, excluding those with benign paroxysmal positional vertigo, medical causes, or moderate-to-severe neurologic deficits. Stroke was defined as any acute infarction on a clinical or research MRI performed within 14 days of dizziness onset.
Results:
From November 21, 2009, to March 29, 2013, we identified 26 patients with acute ischemic stroke presenting with dizziness and either mild or no general neurologic deficits. Infarction volume was small (<1cm3) in 19 (73%), moderate (≥1-<10cm3) in 2 (8%), and large (>10cm3) in 5 (19%). The proportion of cases arriving within 3, 4.5, and 6 hours of symptom onset was 38% (10), 38% (10), and 46% (12). Two cases were treated with thrombolysis. Half of all cases were already prescribed a statin medication at the time of presentation and 42% (11) were already prescribed an antiplatelet or anticoagulant. One patient met clinical eligibility for sub-occipital craniectomy. Three patients were discharged to a skilled nursing facility (1) or acute rehabilitation (2), whereas the majority (22; 85%) were discharged home.
Conclusion:
In this single center study which used rigorous surveillance and imaging-based methods to capture cases of acute dizziness-ischemic stroke with only mild or no general neurologic deficits, we found that a minority of patients met time requirements for acute treatments, nearly half were already on secondary prevention medications, and the majority did not require discharge to a skilled nursing facility or acute rehabilitation.
Does the literature indicate that patients with a stroke have better outcomes after receiving rehabilitation from an acute rehabilitation facility than from a skilled nursing facility?
