By Matthew E. Fink, MD

Louis and Gertrude Feil Professor in Clinical Neurology and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports he is a consultant for Procter & Gamble and Pfizer.

SOURCE: Atzema CL, et al. Outcomes among patients discharged from the emergency department with a diagnosis of peripheral vertigo. Ann Neurol 2016;79:32-41.

Dizziness and vertigo are common reasons for patients to seek help in an emergency department (ED). There is always fear and concern on the part of the providers that a stroke may have caused the symptoms. These investigators reviewed all patients discharged from the ED in a large hospital in Ontario, Canada, between 2006 and 2011 with a diagnosis of peripheral vestibular disorder to determine which patients subsequently had a stroke.

They reviewed the records of 41,794 qualifying patients, and only 76 subsequently had a stroke (0.18%). However, when comparing a similar group of patients discharged from the ED with renal colic, as a control group, the relative risk of 30-day stroke in the vertigo group was 9.3 times the risk of stroke in the renal colic group. The time of greatest risk for stroke was 1 week after hospital discharge. However, the rate of stroke in this group of patients is extremely low, and unless there are associated neurological symptoms and signs, there is no need for extensive ED evaluation. But, close follow-up after discharge is certainly recommended.