• Anand K Bery, Mukul Sharma, Marie-Joe Nemnom, Peter Johns, Daniel A Lelli, SivilottiMarco L AMLADepartment of Emergency Medicine, Queen's University, Kingston, ON, Canada., Marcel Émond, Ian G Stiell, Grant Stotts, Jacques Lee, Andrew Worster, Judy Morris, CheungKa WaiKWDepartment of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada., Albert Y Jin, Wieslaw J Oczkowski, Demetrios J Sahlas, Heather E Murray, Ariane Mackey, Steve Verreault, Marie-Christine Camden, Samuel Yip, Philip Teal, David J Gladstone, Mark I Boulos, Nicolas Chagnon, Elizabeth Shouldice, Clare Atzema, Tarik Slaoui, Jeanne Teitelbaum, George A Wells, and Jeffrey J Perry.
• Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
• CJEM. 2022 Dec 1; 24 (8): 844852844-852.

ObjectiveStroke presenting as dizziness is a diagnostic challenge in frontline settings, given the multitude of benign conditions that present similarly. The risk of stroke after episodic dizziness is unknown, leading to divergent guidance on optimal workup and management. Prior TIA risk scores have shown a history of dizziness is a negative predictor of subsequent stroke. Our objective was to assess the subsequent stroke risk within 90 days following emergency department assessment (ED) for isolated dizziness diagnosed as TIA during the index visit.MethodsWe conducted prospective, multicenter cohort studies at 13 Canadian EDs over 11 years. We enrolled patients diagnosed with TIA and compared patients with isolated dizziness to those with other neurological deficits. Our primary outcome was subsequent stroke within 90 days. Secondary outcomes were subsequent stroke within 2, 7, and 30 days, respectively, as well as subsequent TIA within 90 days.ResultsOnly 4/483 (0.8%) patients with isolated dizziness had a stroke within 90 days compared to 320/11024 (2.9%) of those with any focal neurological sign or symptom (RR 0.29, 95% CI 0.11-0.76). Over the first 90 days, the two groups differ significantly in their probability of stroke (p = 0.007). Subsequent TIA was also significantly less common in the isolated dizziness group (1.7% vs. 5.6%, p = 0.001) with a relative risk of 0.30 (95% CI 0.15-0.60).ConclusionThe risk of subsequent stroke following ED presentation for TIA is low when the presenting symptoms are isolated dizziness.© 2022. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).

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