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Vestibular symptoms in acute hemispheric strokes

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Abstract

A prospective study focused on whether vestibular symptoms are seen in acute hemispheric strokes, and if so, the frequency and lateralization of causative lesions on MRI. Among 668 patients with hemispheric infarction, we prospectively included those with chief complaints of acute vestibular symptoms, such as vertigo/dizziness, nausea/vomiting and gait instability, in the “VS” group. We also retrospectively reviewed MRI of all stroke patients, and included cases with the findings of parieto-insular vestibular cortex (PIVC) or temporo-periSylvian vestibular cortex (TPSVC) lesion by diffusion-weighted MRI, in the “PIVC” group. Eight patients were found to belong to the VS group, and six other patients to the PIVC group. In the VS group, six patients had the responsible lesion on the right hemisphere, in the middle cerebral artery (MCA) territory except one case and two on the left MCA territory, particularly in the insula, retro-insular region, superior/middle temporal gyrus, angular gyrus, supra-marginal gyrus, putamen and hippocampus/para-hippocampal gyrus. In contrast, none of the six other patients of the PIVC group had vestibular symptoms. One of them had a lesion in the right hemisphere and five in the left hemisphere. Four lesions were located in the insular area and two within the temporal lobe. In conclusion, cerebral hemispheric infarction limited to the PIVC or TPSVC does not necessarily cause vertigo. However, unilateral hemispheric infarctions, restricted to the areas belonging to the vestibular cortical network may cause vestibular symptoms. The lesions responsible for vestibular symptoms are located more often in the right hemisphere.

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Acknowledgements

The authors thank Professor Michael G. Halmagyi for his critical reading and suggestions.

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Authors and Affiliations

  1. Department of Neurology, Neurological Center, Asanogawa General Hospital, Naka 83, Kosaka-machi, Kanazawa, 920-8621, Ishikawa, Japan

    Shuichiro Eguchi, Genjiro Hirose & Miho Miaki

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  1. Shuichiro Eguchi
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  2. Genjiro Hirose
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  3. Miho Miaki
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Correspondence to Genjiro Hirose.

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The authors declare that they have no conflict of interest.

Ethical standards

The study protocol and patient information and other relevant study documentation were approved by the Hospital’s Institutional Review Board. All patients agreed for their medical data to be used for this study without the identity of the subjects.

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Eguchi, S., Hirose, G. & Miaki, M. Vestibular symptoms in acute hemispheric strokes. J Neurol 266, 1852–1858 (2019). https://doi.org/10.1007/s00415-019-09342-9

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  • DOI: https://doi.org/10.1007/s00415-019-09342-9

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