Res Vestib Sci.  2014 Jun;13(2):34-40.

Predictors of Cerebrovascular Causes in the Emergency Department Patients with Dizziness: Application of the ABCD2 Score

• Kim HJ
• Kim SI
• Kang JH
• Sung KB
• Lee TK
• Park JY

Abstract

BACKGROUND AND OBJECTIVES
Dizziness is a common presenting complaint in the emergency department (ED) that had various pathologic causes. Most of dizziness can be caused by benign origin but identifying cerebrovascular causes among ED patients with dizziness is a diagnostic challenge. ABCD2 score is clinical prediction tool for assessing the risk of stroke after a transient ischemic attack. We evaluated predictors of cerebrovascular causes and whether ABCD2 score would identify cerebrovascular events among ED patients with dizziness.
MATERIALS AND METHODS
We analyzed 180 patients (> or =20 years old) with dizziness in ED, Presbyterian Medical Center (single-center prospective observational study) for 2 months. Type of dizziness, associated symptoms, past medical history, ABCD2 score (0-7), neuro-otologic examination, diagnosis were recorded.
RESULTS
The incidence of dizziness is 3.6% (192/5,374). After excluding 12 patients, 180 patients (56% female, mean 59 years) met our eligibility criteria and were included in the final analysis. Cerebrovascular causes of dizziness were found in 10% (18/180): 3 vertebrobasilar insufficiency, 9 cerebellar infarction, 1 right middle cerebral artery (MCA) infarction, 1 right MCA giant aneurysm, 1 lateral medullary infarction, 1 posterior limb of internal capsule infarction, 1 intracerebral hemorrhage of cerebellum. Patients with cerebrovascular cause were males and had more hypertension, diabetes mellitus, imbalance, abnormal neuro-otologic findings and ABCD2 score.
CONCLUSION
Several clinical factors (hypertension, diabetes, abnormal neuro-otologic findings ABCD2 scores) favored a diagnosis of central neurological causes of dizziness. ABCD2 score is a simple and easily applied tool for distinguishing cerebrovascular from peripheral causes of dizziness in ED.

Keyword

Dizziness; Stroke; Emergency medicine

MeSH Terms

Aneurysm
Cerebellum
Cerebral Hemorrhage
Diabetes Mellitus
Diagnosis
Dizziness*
Emergency Medicine
Emergency Service, Hospital*
Extremities
Female
Humans
Hypertension
Incidence
Infarction
Internal Capsule
Ischemic Attack, Transient
Male
Middle Cerebral Artery
Prospective Studies
Protestantism
Stroke
Vertebrobasilar Insufficiency