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Does intracerebral haemorrhage mimic benign dizziness presentations? A population based study
  1. Kevin A Kerber1,
  2. James F Burke1,2,
  3. Devin L Brown1,2,
  4. William J Meurer1,3,
  5. Melinda A Smith1,
  6. Lynda D Lisabeth1,2,4,
  7. Lewis B Morgenstern1,2,4,5,
  8. Darin B Zahuranec1,2
  1. 1Department of Neurology, University of Michigan Health System, Ann Arbor, Michigan, USA
  2. 2Stroke Program, University of Michigan Health System, Ann Arbor, Michigan, USA
  3. 3Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
  4. 4Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  5. 5Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  1. Correspondence to Dr K A Kerber, Department of Neurology, University of Michigan Health Systems, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA; kakerber{at}umich.edu

Abstract

Objective A principal reason to order a head CT scan for dizziness patients is to exclude stroke. As CT imaging is substantially limited in assessing for any acute lesions other than haemorrhage, the most important stroke syndrome adequately evaluated by CT is intracerebral haemorrhage (ICH). A population based stroke database was used to assess the frequency with which ICH might mimic a benign dizziness presentation.

Methods The Brain Attack Surveillance in Corpus Christi project was used to identify cases of ICH from 1 January 2000 to 26 December 2007. The hospital records of ICH cases with a National Institutes of Health Stroke Scale of <2 were abstracted for more detailed information. Cases were classified as benign dizziness presentations when isolated dizziness and a normal general neurological examination were documented.

Results Of 595 ICH cases, only 2.2% (13 of 595) had dizziness as the primary presenting symptom and a National Institutes of Health Stroke Scale of <2. No case mimicked a benign dizziness presentation. Only one case had isolated dizziness symptoms but this patient had dysmetria documented on the examination. All other cases had either focal or global neurological symptoms or examination abnormalities.

Conclusions This study provides further support for the notion that ICH is highly unlikely to mimic a benign dizziness presentation. Coupled with the limitations of CT to show acute ischaemia in the posterior fossa, these results suggest that screening for ICH may not be necessary in benign appearing dizziness presentations although more research is needed.

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Footnotes

  • Funding This project was funded by the National Institutes of Health Grant R01 NS38916.

  • Competing interests None.

  • Ethics approval The study was approved by the University of Michigan Institutional Review Board and by the institutional review boards of the Corpus Christi hospitals.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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