Can a stroke cause dizziness?

Can Stroke Cause Dizziness?

Yes, stroke can definitely cause dizziness, particularly strokes affecting the vertebrobasilar system (posterior circulation), which includes the brainstem and cerebellum. 1

Dizziness as a Stroke Symptom

Dizziness is a well-recognized manifestation of posterior circulation stroke and transient ischemic attack (TIA):

• Vertebrobasilar strokes commonly present with dizziness, imbalance, and incoordination as primary symptoms, along with ataxia, cranial nerve deficits, and visual field loss. 1
• Dizziness is the most common symptom of posterior circulation TIA and can occur more frequently before posterior circulation strokes develop. 2
• The American Heart Association guidelines specifically list dizziness among the symptoms resulting from ischemia or infarction in the vertebrobasilar system. 1

Frequency and Location

Stroke is found in approximately 11% of patients presenting with isolated vertigo or dizziness attack without other obvious neurological symptoms. 3

• Vertigo occurs in about 3.9% of all acute stroke patients, but this represents a significant subset where dizziness is the presenting complaint. 4
• The cerebellum is the most common location (84% of stroke-related vertigo cases), followed by the medulla, pons, and basilar artery territory. 4, 3
• Approximately 25% of patients with acute vestibular syndrome (sudden persistent vertigo with nausea, vomiting, gait instability) have stroke as the underlying cause. 1

Critical Diagnostic Considerations

Cerebellar stroke can be particularly difficult to diagnose because the chief complaints are often just dizziness, vertigo, and vomiting—symptoms easily mistaken for benign vestibular disorders. 1

High-Risk Features Suggesting Stroke Rather Than Benign Causes:

• Sudden onset of persistent symptoms (rather than brief positional episodes). 1
• Associated neurological symptoms including dysarthria, dysmetria, dysphagia, sensory or motor loss, or Horner's syndrome. 1
• Abnormal nystagmus patterns: downbeating nystagmus, direction-changing nystagmus without head position changes, or gaze-holding nystagmus. 1
• Cranial nerve deficits, ataxia, visual field loss, or imbalance accompanying the dizziness. 1, 5
• Failure to respond to conservative vestibular treatments should raise concern that the diagnosis is not benign positional vertigo. 1

Clinical Pitfalls to Avoid

It is a common pitfall to miss truncal ataxia during bedside examination in patients with cerebellar stroke presenting with dizziness. 1

• Initial CT scans can be normal in up to 25% of cerebellar stroke patients, making early diagnosis challenging. 1
• Elderly patients with long-standing recurrent stroke may not manifest frank vertigo but rather present with episodes of "vague dizziness" or vestibular disturbance. 1
• Dizziness without true vertigo (spinning sensation) may indicate lightheadedness or presyncope rather than stroke, but posterior circulation ischemia should still be considered. 1

Immediate Recognition and Response

The American Heart Association recommends using the FAST method (Face drooping, Arm weakness, Speech difficulties, Time) for immediate stroke recognition. 6, 5

• Activate emergency medical services immediately when stroke is suspected in a patient with dizziness plus neurological symptoms. 6
• Note the exact time of symptom onset, as this is critical for treatment decisions regarding thrombolytic therapy. 6, 5
• Transport to a facility capable of advanced stroke care with immediate brain imaging is essential. 6

Long-Term Sequelae

Chronic dizziness frequently persists after ischemic stroke, even in patients without other obvious neurological sequelae. 7

• All stroke patients in one study complained of dizziness, especially imbalance, during follow-up evaluation. 8
• Visual complaints occur in 56% of post-stroke patients with dizziness and correlate with abnormalities in oculomotor and vestibular testing. 8