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Benign Vertigo vs. Stroke: How to Differentiate & Why Proper Testing Matters

patient waiting to get a brain scan for stroke vs. vertigo

Understanding the difference between vertigo vs stroke can help healthcare providers save tens of thousands of lives each year – and a new testing technique can help.

You’re about to learn the difference between benign vertigo and stroke, and how each condition is tested and diagnosed.

Understanding these differences has major implications for healthcare providers and patients alike.

Comparing the Symptoms of Stroke vs. Vertigo

Before we discuss how a stroke is diagnosed when vertigo is present, let’s briefly cover the cause of a stroke.

A stroke occurs when the supply of blood in the brain is compromised by a clogged or burst artery. It’s a medical emergency because, until the stroke is treated, brain damage continues to occur.

The hallmark symptoms of a stroke include facial drooping, arm weakness, and slurred speech. Atypical symptoms can include headache, nausea, numbness, and last but not least – vertigo.

Vertigo is a sensation of spinning and dizziness that is often accompanied by nausea. It can result from problems in the inner ear (considered benign vertigo), brain, or sensory nerve pathways.

While the symptoms of vertigo sometimes overlap with stroke, they are atypical symptoms. Doctors are often not as quick to catch the atypical signs of a stroke compared to the hallmark symptoms of a stroke.

This can lead to misdiagnoses, which unfortunately lead to increased disability or even death, as brain damage increases the longer a stroke goes untreated.

Ordering the right test at the right time can make a serious difference.

Testing & Timing Make the Difference

A brain scan is the most common way to diagnose a stroke so that doctors can proceed with proper treatment. These tests include MRI scans or CT scans to detect changes in the brain.

MRI scans are superior at detecting strokes, but are more expensive. This makes CT scans more popular, and they are ordered for about 40% of emergency room admissions for dizziness.

However, CT scans miss more than 80% of strokes in the brain stem and cerebellum.

This is an alarming problem because brain stem strokes and cerebellar strokes are particularly known to cause vertigo.

In fact, about 3% of all hospital admissions for vertigo are individuals experiencing cerebellar strokes.

This could imply that doctors should opt for an MRI scan over a CT scan when vertigo is present. Unfortunately, even if this precaution is taken, it does not completely solve the problem.

MRI scans cannot detect a stroke in the brain stem or cerebellum until 48 hours after the symptoms first start. This puts doctors in a tricky position.

What kinds of tests should be conducted when vertigo is present, and when?

Tests Used to Diagnose Vertigo vs Stroke

When vertigo is caused by problems in the inner ear, it’s considered benign vertigo (non-harmful vertigo). Doctors often check for benign vertigo if it’s the only symptom present.

If other symptoms are present, such as nystagmus (rhythmic, involuntary eye movements) and nausea/vomiting, there’s a new test available to detect a stroke called the HINTS test (Head-Impulse/Nystagmus/Test-of-Skew).

It’s a 3-part eye movement test where specialists analyze minute changes in eye movement to detect a stroke. It only works if the medical practitioners have been formally trained in this procedure.

During the HINTS test, a patient is asked to look at a target on the wall and keep her eyes on the target. Then, the patient’s head is moved side to side as doctors analyze eye movement.

While the HINTS test may help detect a stroke faster and minimize disability, resources for the HINTS test are limited, as it takes months or years of mentorship to train a physician to perform the test.

New Eye-Movements Tests for Stroke-Induced Vertigo

Fortunately, researchers have created a service to help with this called “Tele-Dizzy.” This service involves a pair of goggles that records eye movements and sends the results for specialists to interpret remotely.

David Newman-Toker, the main specialist spearheading this project, offers “Tele-Dizzy” services at the Johns Hopkins Hospital during weekday business hours.

While this means crucial technology is only available on a limited basis, the researchers are working to expand it to other hospitals who can provide care around the clock.

This provides hope for future generations to improve accuracy of diagnostic testing for stroke.

But what does this mean for you today?

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Striving for Progress

The best way to save a life is to know the symptoms of a stroke and seek emergency medical attention. In the emergency room, pay attention to which tests the doctor orders, and when.

If a CT scan is ordered, and your loved one has vertigo, ask the treating physician if they can accommodate an MRI scan. This can increase chances of an accurate diagnosis if the vertigo is caused by stroke.

It will take time for hospitals to adopt the HINTS test, if at all. Hopefully, you can make a difference by asking the right questions of your loved one’s treating physician.

Also, help educate your family and friends of the difference between stroke vs vertigo. You can help save a life!

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