Incidence of acute cerebral infarction or space occupying lesion among patients with isolated dizziness and the role of D-dimer

• Published in: PloS one Vol. 14; no. 3; p. e0214661
• Main Authors: Jo, Sion, Jeong, Taeoh, Lee, Jae Baek, Jin, Youngho, Yoon, Jaechol, Park, Boyoung
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28-03-2019; Public Library of Science (PLoS)
• Subjects: Accuracy; Acute Disease; Aged; Ambulatory care; Analysis; Aneurysm; Aneurysms; Biology and Life Sciences; Biomedical research; Brain; Brain research; Cerebellum; Cerebral infarction; Cerebral Infarction - complications; Cerebral Infarction - epidemiology; Cerebral Infarction - metabolism; Clinical medicine; Complications and side effects; Diagnostic imaging; Dimers; Dizziness; Dizziness - complications; Embolisms; Emergency medical care; Emergency medical services; Female; Fibrin Fibrinogen Degradation Products - metabolism; Gait; Hospital costs; Humans; Incidence; Infarction; Magnetic resonance; Magnetic resonance imaging; Male; Medical imaging; Medical tests; Medicine; Medicine and Health Sciences; Meningioma; Middle Aged; Movement disorders; Neuroimaging; Nose; Occipital lobe; Patients; Research and Analysis Methods; Retrospective Studies; Risk factors; Sensitivity analysis; Stroke; Studies; Subgroups; Systematic review; Vertigo
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0214661

To determine the incidence of acute cerebral infarction or space occupying lesion (SOL) among patients with isolated vertigo or dizziness (IVD) and to evaluate the role of cerebellar function test (CFT) and D-dimer to discriminate ACI/SOL and non-ACI/SOL.
A retrospective study of consecutive emergency department (ED) patients with IVD during one year was conducted. ACI was based on the diffusion-weighted magnetic resonance imaging (DW-MRI), and SOL was based on the concurrent MRI sequences. A sensitivity analysis of CFT and D-dimer was also performed.
Among the 468 patients enrolled, 13 patients (2.8%) had ACI, 11 at cerebellum, 1 at occipital lobe, and 1 at centrum semiovale. Twenty-five patients (5.3%) had SOL. Aneurysm is most frequent (n = 7), followed by meningioma (n = 4) and venous anomaly (n = 4). In total, ACI/SOL was found in 8.1% (n = 38). Abnormal findings in finger-to-nose (FN), heel-to-shin (HTS), and rapid alternative movement (RAM) tests were significantly higher in ACI or ACI/SOL group, while gait disturbance, tandem gait abnormality, and Romberg's test were not. CFT sensitivities were low for ACI as well as for ACI/SOL, but specificities were high for ACI and ACI/SOL. D-dimer level showed a sensitivity of 100% at >0.18 mg/L for ACI and >0.15 mg/L for ACI/SOL. However, specificity was low at corresponding D-dimer level. Among the subgroup (n = 411) who did not show any abnormality in CFT, 9 patients (2.2%) had ACI, and 33 patients (8.0%) had ACI/SOL.
The present study reports a clinically significant incidence of ACI/SOL among ED patients with IVD. D-dimer showed high sensitive and low specificity, while CFT showed low sensitivity and high specificity.