Isolated Vertigo and Dizziness of Vascular Origin

Introduction: Vertigo of vascular origin is usually limited to migraine, transient ischemic attacks, and ischemic or hemorrhagic stroke. Excluding migraines, focal neurologic deficits usually allow a fast identification of the impending neural damage and permit a rapid transfer to a stroke team. Few authors have considered that a vascular origin should be thought of in cases of positional vertigo or vertigo not associated with neurologic signs (ie, isolated vertigo) in patients with vascular disease risk factors. Objectives: (1) To present a case series of vertigo and dizziness without vertigo of probable vascular origin and (2) to perform an evidence-based review regarding the incidence of isolated vertigo and dizziness of vascular origin. Design: Retrospective nonrandomized case series. Setting: Tertiary referral centre. Method: (1) All patients from a vertigo clinic found to have vertigo of potential vascular origin had a complete neuro-otologic examination and were investigated by magnetic resonance angiography. (2) A MEDLINE literature search was performed using specific search terms to identify pertinent publications concerning this pathology. They were reviewed and graded according to the quality of their evidence. Results: We identified nine cases of vertigo and dizziness without vertigo of probable vascular origin. We identified 27 818 potentially pertinent articles. A detailed review yielded 13 studies for further analysis. Although isolated vertigo has frequently been reported as the only symptom in case series of cerebellar infarcts, only one article discussed its incidence. Conclusion: Vascular origin should be considered in cases of positional vertigo and isolated vertigo or dizziness when the etiology remains unclear. A single study has determined that 52% of patients with isolated vertigo of unclear etiopathology have posterior circulation anomalies.