Long-term Prognosis of Patients Presenting First-ever Vestibular Symptoms in a Community-based Study

• Type: Article in International Scientific Journal
• Date: 2014

Authors

Rui Felgueiras (Author) Other; Rui Magalhaes (Author) ICBAS; Manuel Correia (Author) Other; Maria Carolina Silva (Author) FCUP

Journal

Title: Journal of Stroke and Cerebrovascular Diseases

Vol. 23

Pages: 2190-2198

ISSN: 1052-3057

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 3 Citations

Scopus - 3 Citations

Scientific classification

FOS: Medical and Health sciences > Basic medicine

Other information

Authenticus ID: P-009-TJM

DOI: 10.1016/j.jstrokecerebrovasdis.2014.04.033

Abstract (EN): Background: Vestibular symptoms (VSs) are frequent complaints in patients attending ambulatory care and the emergency room. They may represent a peripheral vestibular disorder or a stroke/transient ischemic attack (TIA), yet many patients have VSs that cannot be clearly classified at presentation. This study aims to characterize and determine the long-term prognosis of these patients. Methods: In a prospective community-based study involving 104,700 individuals registered at 4 health centers of Northern Portugal, patients with a first-ever-in-lifetime focal neurologic symptom (FNS) were ascertained using comprehensive methods, including referrals from physicians working in the study area and data retrieved from emergency/discharge records. Physicians were encouraged to report/notify any patient who might have experienced an FNS, including those with vertigo or vertigo-like symptoms, imbalance, presyncope, or nonspecific dizziness. After neurologic assessment patients were classified as having a peripheral vestibular symptom (pVS), a stroke/TIA, or an unclassified vestibular symptom (uVS). They were followed up 7 years after the index event at the outpatient clinic; predictors of survival free from stroke or vascular events were determined using Cox proportional hazards models. Results: Of the 1163 patients with an FNS, 360 (31.0%) were included, 16.7% had a stroke/TIA, 57.8% had pVS, and 25.6% had uVS. Most patients presented only isolated VSs (62.8%); 63% were women and mean age was 60.1 years (standard deviation = 16); hypertension (47.8%), hypercholesterolemia (41.9%), and diabetes (19.2%) were the most prevalent vascular risk factors (VRFs). Cranial computed tomography (CT) scan was performed in 63.3%. Adjusting for age, sex, VRFs, and diagnosis (TIA, pVS and uVS), the long-term risk of stroke was higher when CT showed silent infarctions (hazard rate [HR] = 3.96; 95% confidence interval [CI], 1.63-9.60) and the risk of vascular events (stroke, myocardial infarction, or vascular death) was higher in patients with 2 or more VRFs (HR = 2.70; 95% CI, 1.25-5.86). Identical results were obtained when restricting the model to patients with pVS or uVS. Conclusions: First-ever-in-lifetime VSs are common in patients with FNS and may represent a good opportunity for preventing a serious vascular event, particularly in patients with vascular comorbidity (silent infarctions and VRFs).

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 9