Rozpoznawanie ostrego niedokrwienia mózgu u pacjentów z zawrotami głowy

In Poland, presumably about 157,000 patients every year present to emergency departments due to vertigo. The differential diagnosis of this condition is broad, with dangerous causes accounting for approximately 15% of cases, including acute cerebral ischaemia which accounts for 2.2%. The present approach to the diagnosis of vertigo is based on the TiTrATE algorithm (Timing, Triggers, And Targeted Examinations), which enables the identification of six syndromes, four of which are important in the context of acute cerebral ischaemia. Triggered episodic vestibular syndrome (incidents of vertigo provoked by specific activities and events) is rarely caused by stroke (in the posterior cranial fossa), and more often by benign paroxysmal positional vertigo or orthostatic hypotension. One of the most common dangerous causes of spontaneous episodic vestibular syndrome is a transient ischaemic attack. Post-exposure acute vestibular syndrome may be caused by vertebral artery dissection. The prototype cause of spontaneous acute vestibular syndrome is vestibular neuritis, and distinguishing it from stroke is a major challenge, especially given the relatively low usefulness of neuroimaging (even of magnetic resonance imaging) in the acute phase of the disease. The HINTS test (head impulse — nystagmus — test of skew) is the best method of distinguishing between these two conditions. The presence of at least one of the following features indicates damage to the central nervous system: abnormal head impulse test, directional changing/vertical/rotational nystagmus, or the presence of skew deviation.