ISOLATED VERTIGO AS A MANIFESTATION OF VERTEBROBASILAR ISCHEMIA

Objective: We sought to demonstrate that isolated episodes of vertigo can be the only manifestation of vertebrobasilar ischemia. Background: Isolated persistent vertigo is classically ascribed to labyrinthine d isorders and is only rarely considered to reflect vertebrobasilar isch emia. Methods: We retrospectively analyzed all of the records of the S aint Louis University Stroke Registry between January 1, 1992 and Sept ember 1, 1993. We set out to identify those patients discharged with a diagnosis of transient ischemic attack (TIA) in the vertebrobasilar s ystem. We reviewed their clinical records and the results of their dia gnostic studies. Results: We screened 600 admissions and found 29 pati ents with vertebrobasilar circulation TIAs. Of these, five men and one woman had episodic vertigo for at least 4 weeks as their only present ing symptom. All six patients had one of two abnormal patterns on magn etic resonance angiography (MRA): focal basilar stenosis or widespread vertebrobasilar slow flow. In three patients. the MRA findings were c onfirmed by cerebral angiography. Five patients were treated with warf arin and one with aspirin. Two patients developed brainstem infarction s, one of them fatal. Conclusions: Isolated vertigo can be the only ma nifestation of vertebrobasilar ischemia. Its frequency may be underest imated in clinical practice. Noninvasive testing is helpful both for d iagnosis and follow-up.