The most frequent signs were unilateral limb weakness (38%), gait ataxia (31%), unilateral limb ataxia (30%), dysarthria (28%) and nystagmus (24%) (14,15). In 407 patients from the NEMC-PCR, the most frequent presenting symptoms were dizziness (47%), unilateral limb weakness (41%), dysarthria (31%), headache (28%) and nausea or vomiting (27%). The presenting signs and symptoms of posterior circulation stroke are often non-specific and fluctuating, adding to the challenge in making the diagnosis (14). Neurologic diagnoses (approximately 11%).Otovestibular diagnoses (approximately 33%).General Medical (including cardiovascular) Diagnoses (approximately 50%):.The differential diagnosis of dizziness can include (2,3,13-15): Signs, Symptoms, and Differential Diagnosis Patients with posterior circulation strokes are misdiagnosed more than twice as often as those with anterior circulation strokes (12). Approximately one-third of posterior circulation strokes are caused by occlusive disease within the intracranial vertebral, basilar, and posterior cerebral arteries and the vertebral arteries in the neck and the innominate and subclavian arteries in the chest. Causes of posterior circulation ischemia include atherosclerosis, embolism, dissection, and dolichoectasia (elongation and tortuosity) of the vertebral and basilar arteries. Twenty percent of ischemic events in the brain involve the posterior circulation. Stroke is a leading cause of disability in the United States (1,4-6). How do you approach the weak and dizzy patient? Strokes are the final diagnosis for 3–5% of these ED visits for dizziness and vertigo (3). She came to your ED rather than returning to the other hospital because her mother wanted her to get a second opinion at a different hospital since she has gotten worse and is so weak that she is unable to walk today.ĭizziness and vertigo account for approximately 4.4 million emergency department (ED) visits per year (approximately 4% of ED visits) (1).Emergency medicine physicians must distinguish the self-limiting causes of dizziness from the serious causes (2). She returns today because her symptoms have worsened. She was discharged from another ED the day prior to arrival with a diagnosis of influenza and hyperglycemia. Pierce, MD, FACEP (Professor of Emergency Medicine, UT Southwestern Medical Center) // Edited by: Alex Koyfman, MD and Brit Long, MD CaseĪ 39-year-old female with a history of diabetes presents to the ED with dizziness, weakness, and vomiting.
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