Temporal CVA Can Cause Dizziness and Lightheadedness
Yes, a temporal cerebrovascular accident (CVA) can cause dizziness and lightheadedness, particularly when it affects the posterior circulation that supplies blood to the temporal lobe and nearby vestibular structures. 1, 2 Posterior circulation strokes, which include those affecting the temporal region, can present with vertigo, dizziness, and lightheadedness as primary symptoms, sometimes without other obvious neurological deficits.
Mechanism and Presentation
Temporal region CVAs can cause dizziness and lightheadedness through several mechanisms:
- Vertebrobasilar insufficiency: Isolated attacks of vertigo can be the initial and only symptom of vertebrobasilar insufficiency, which may precede a stroke in the vertebrobasilar artery by weeks or months 1
- Posterior circulation involvement: Dizziness with or without associated neurologic symptoms is the most common symptom of posterior circulation transient ischemic attack (TIA) 2
- Isolated presentation: Approximately 17% of patients with isolated posterior inferior cerebellar artery territory infarction present with isolated vertigo, nystagmus, and postural unsteadiness 3
Distinguishing Features from Peripheral Causes
When evaluating dizziness that might be caused by a temporal CVA, look for these key differences from peripheral vestibular disorders:
- Duration of symptoms: Vertigo attacks in vertebrobasilar insufficiency usually last less than 30 minutes and have no associated hearing loss 1
- Nystagmus characteristics: The nystagmus arising from central causes like CVA does not fatigue and is not easily suppressed by gaze fixation 1
- Associated symptoms: Look for additional neurological signs that may accompany dizziness in CVA cases 1
- HINTS examination: When performed by specially trained practitioners, the HINTS examination (Head Impulse, Nystagmus, Test of Skew) can distinguish central causes from peripheral causes with high sensitivity 1
Risk Factors for CVA-Related Dizziness
Several factors increase the risk of experiencing a CVA that presents with dizziness:
- Age over 65 4
- History of heart failure 4
- Atrial fibrillation 4
- Peripheral vascular disease 4
- Hypertension
- Previous TIA 5
Clinical Approach
When evaluating a patient with dizziness or lightheadedness that might be due to a temporal CVA:
Assess symptom characteristics:
- Sudden onset vs. gradual
- Constant vs. episodic
- Triggered by position changes or spontaneous
- Associated symptoms (headache, visual changes, hearing loss)
Perform targeted neurological examination:
- HINTS examination (if trained)
- Assess for subtle focal neurological deficits
- Evaluate gait and balance
Consider urgent neuroimaging:
Pitfalls to Avoid
- Misdiagnosis as benign vertigo: Up to 25% of patients with CVA may present with isolated dizziness without other focal neurological findings 1
- Delayed diagnosis: Symptoms may be attributed to more common peripheral causes like BPPV or vestibular neuritis
- Inadequate imaging: CT scans may miss small infarcts in the posterior fossa; MRI is preferred when available
- Failure to recognize TIAs: Transient dizziness episodes may be TIAs that precede a more severe stroke 2
Management Implications
If temporal CVA is suspected as the cause of dizziness and lightheadedness:
- Urgent neurological consultation
- Appropriate neuroimaging (preferably MRI with diffusion-weighted imaging)
- Vascular assessment of the vertebrobasilar system
- Initiation of appropriate stroke prevention measures if confirmed
- Management of modifiable risk factors
Remember that dizziness from a temporal CVA represents a medical emergency requiring prompt evaluation and treatment to prevent progression to a larger stroke with potentially devastating consequences.