To Identify the Clinical Parameters Suggestive of Stroke in Patients Presenting to Emergency Department with Vertigo

  • Thulasi Kumar Final year resident, Emergency department, BGS Global hospital, Bengaluru
  • Dr. Srinivas DR Consultant ENT, BGS Global hospital, Bengaluru
Keywords: Vertigo, Stroke, Peripheral, Central, Clinical assessment, MRI


Background and Purpose: Investigating every vertigo patient for central or peripheral MRI and other treatments is expensive and taxing for the system. Thus, emergency physicians must identify stroke patients and give immediate treatment to minimize disastrous results.

Methods: 500-bed BGS Global hospital prospective cohort research. Consecutive vertigo patients endure history, head impulse, nystagmus, skew deviation, and neurological symptoms such leg or truncal ataxia. Scheduled brain MRIs. MRI found strokes. Clinical assessment and normal MRI found peripheral lesions.

Results: Of the 102 acute vertigo patients, 70 were peripheral and 32 central (29 posterior circulation stroke, 2 anterior circulation, and 1 central venous thrombosis). Vertigo patients averaged 49.64706 ± 14.3931 (SD). 36 women, 66 males (64.3%). ED presentation averages 12.54902 ± 10.76355 (SD) hours. Central and peripheral causes were explored. Vomiting, hearing problems, headaches, and tinnitus did not discriminate central from peripheral causes (p <0.01). Diplopia, Dysphagia, Dysarthria, Head impulse test, Nystagmus examination, Skew deviation test, and neurological indicators such limb or truncal ataxia separate central from peripheral causes (p <0.01). Diplopia, Dysarthria, Dysphagia, Nystagmus, Skew deviation, and ataxia have poor sensitivity and high specificity. High-sensitivity, low-specificity head impulse test. This study shows that individual characteristics cannot distinguish central from peripheral vertigo. The study showed good sensitivity 92.31% (0.63 to 0.99) and specificity 100% (0.87 to 1). This test distinguishes central from peripheral vertigo.

Conclusions: Absence of Diplopia, Dysphagia, Dysarthria, abnormal head impulse test, No direction-changing Nystagmus, and absence of Skew deviation in the first clinical visit with vertigo can reliably exclude central cause and discharged home from ED safely without further investigations and imaging.




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Author Biographies

Thulasi Kumar, Final year resident, Emergency department, BGS Global hospital, Bengaluru



Dr. Srinivas DR, Consultant ENT, BGS Global hospital, Bengaluru




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DOI: 10.26838/MEDRECH.2023.10.4.546
Published: 2023-07-06
How to Cite
Kumar T, DR S. To Identify the Clinical Parameters Suggestive of Stroke in Patients Presenting to Emergency Department with Vertigo. Med. res. chronicles [Internet]. 2023Jul.6 [cited 2024Jun.20];10(4):222-41. Available from:
Original Research Article