Abstract
BACKGROUND: Distinguishing ischemic stroke in patients presenting with isolated dizziness or vertigo (IDV) from more benign causes remains a significant clinical challenge. Current understanding of the specific clinical and imaging characteristics that differentiate IDV strokes from strokes with non-isolated symptoms (NIDV) is incomplete. OBJECTIVE: This study aimed to systematically compare the clinical characteristics, with a specific focus on infarction topography and lipid profiles, between patients with acute cerebral infarction presenting with IDV and those with NIDV. METHODS: In this retrospective cohort study, we analyzed 136 patients with Magnetic Resonance Imaging (MRI)-confirmed acute cerebral infarction who presented with dizziness/vertigo. Patients were classified into IDV (n = 53; NIHSS = 0, no focal deficits) and NIDV (n = 83; NIHSS>0 or focal deficits) groups based on a standardized neurological assessment. A comprehensive comparison of clinical characteristics was performed, including demographics, vascular risk factors, fasting lipid profiles, and neuroimaging features. Differences between groups were assessed using univariate analyses (Student's t-tests, Chi-square tests, etc.), with variables significant at p < 0.10 eligible for inclusion in a multivariate logistic regression model to identify factors independently associated with the stroke phenotype (IDV vs. NIDV). RESULTS: Univariate analysis revealed that the primary differences between groups lay in infarction topography and lipid profiles. Specifically, infarctions in the cerebellar hemisphere (47.2% vs. 25.3%; p = 0.009) and other cerebellar regions (18.9% vs. 4.8%; p = 0.009) were significantly more prevalent in the IDV group, whereas pontine infarctions were strongly associated with the NIDV group (13.2% vs. 41.0%; p = 0.001). Concurrently, the IDV group exhibited a more atherogenic lipid profile, with significantly higher levels of low-density lipoprotein cholesterol (LDL-C) (3.07 ± 0.89 vs. 2.71 ± 0.75 mmol/L, p = 0.013). Notably, the prevalence of acute lacunar infarcts was also higher in the IDV group (17.0% vs. 4.8%, p = 0.019). A history of hypertension was less prevalent in the IDV group (60.4% vs. 83.1%, p = 0.003), though this association was attenuated in the multivariate model (p = 0.052). In the multivariate model, pontine infarction remained a strong negative predictor of the IDV phenotype (adjusted OR = 0.30, p = 0.016), while a higher LDL-C level emerged as an independent positive predictor (adjusted OR = 1.67 per mmol/L, p = 0.036). CONCLUSION: In patients with confirmed acute cerebral infarction, those presenting with isolated dizziness/vertigo (IDV) represent a distinct phenotype characterized by a predisposition to cerebellar infarctions and a higher atherogenic lipid burden, specifically elevated LDL-C. These findings challenge the notion of a benign underlying vasculopathy in IDV stroke and underscore the necessity of comprehensive vascular assessment, including lipid profiling, in this patient population.