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Neurol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Recurrent attacks of vertigo account for 2.6 million emergency department visits per year in the USA, of which more than 4% are attributable to ischemic infarction. However, few studies have investigated the frequency of attacks of vertigo before an ischemic stroke.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We conducted this retrospective analysis and manually screened the medical records of 231 patients who experienced recurrent attacks of vertigo prior to an ischemic stroke. Patients were divided into four different groups based on the frequency of vertigo attacks as well as the region of ischemic infarction. Those with \u22642 attacks of vertigo preceding the ischemic stroke were defined as the low-frequency group. Those with \u22653 attacks were defined as the high-frequency group. Clinical parameters, including vascular risk factors, average National Institutes of Health Stroke Scale (NIHSS) score, and infarction volume, were compared between the groups.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> On analysis, we found that patients with posterior infarction in the high-frequency group exhibited a higher prevalence of vertebral artery stenosis. However, the incidence of diabetes mellitus (DM) was higher in the low-frequency group. In addition, patients with posterior infarction in the low-frequency group were more active in seeking medical intervention after an attack of vertigo. Notably, the brain stem, especially the lateral medullary region, had a higher probability of being involved in posterior infarction in the high-frequency group. However, the cerebellum was more commonly involved in posterior infarction in the low-frequency group.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Our findings indicate that the clinical parameters, including arterial stenosis, DM, and magnetic resonance imaging (MRI) findings, differed between the low- and high-frequency groups. We also found that patients in the low-frequency group were more willing to seek medical intervention after the attacks of vertigo. These findings could be valuable for clinicians to focus on specific examination of the patients according to the frequency of vertigo attacks.<\/jats:p>","DOI":"10.3389\/fneur.2020.593524","type":"journal-article","created":{"date-parts":[[2021,1,10]],"date-time":"2021-01-10T12:36:45Z","timestamp":1610282205000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["New Insights Into Vertigo Attack Frequency as a Predictor of Ischemic Stroke"],"prefix":"10.3389","volume":"11","author":[{"given":"Dongxu","family":"Qiu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwei","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingfeng","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongsen","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2020,12,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3238165","DOI":"10.1155\/2018\/3238165","article-title":"Stroke in the 21(st) century: a snapshot of the burden, epidemiology, and quality of life","volume":"2018","author":"Donkor","year":"2018","journal-title":"Stroke Res Treat."},{"key":"B2","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/S1474-4422(19)30030-4","article-title":"The global burden of stroke: persistent and disabling","volume":"18","author":"Gorelick","year":"2019","journal-title":"Lancet Neurol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1503\/cmaj.110704","article-title":"Preventing stroke after transient ischemic attack","volume":"183","author":"Hill","year":"2011","journal-title":"CMAJ."},{"key":"B4","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1038\/s41572-019-0118-8","article-title":"Ischaemic stroke","volume":"5","author":"Campbell","year":"2019","journal-title":"Nat Rev Dis Primers."},{"key":"B5","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/S1474-4422(12)70299-5","article-title":"Transient isolated brainstem symptoms preceding posterior circulation stroke: a population-based study","volume":"12","author":"Paul","year":"2013","journal-title":"Lancet Neurol."},{"key":"B6","article-title":"Migraine-Associated Vertigo","volume-title":"StatPearls","author":"Hilton","year":"2020"},{"key":"B7","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1017\/S0022215116001079","article-title":"The clinical differentiation of cerebellar infarction from common vertigo syndromes","volume":"10","author":"Nelson","year":"2009","journal-title":"West J Emerg Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1161\/STROKEAHA.117.016979","article-title":"Diagnosing stroke in acute dizziness and vertigo: pitfalls and pearls","volume":"49","author":"Saber Tehrani","year":"2018","journal-title":"Stroke."},{"key":"B9","doi-asserted-by":"publisher","first-page":"E182","DOI":"10.1503\/cmaj.190334","article-title":"Clinical diagnosis of benign paroxysmal positional vertigo and vestibular neuritis","volume":"192","author":"Johns","year":"2020","journal-title":"CMAJ."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3233\/VES-2009-0343","article-title":"Classification of vestibular symptoms: towards an international classification of vestibular disorders","volume":"19","author":"Bisdorff","year":"2009","journal-title":"J Vestib Res."},{"key":"B11","doi-asserted-by":"publisher","first-page":"379","DOI":"10.3233\/VES-190648","article-title":"Use of the Barany Society criteria to diagnose benign paroxysmal positional vertigo","volume":"28","author":"Yao","year":"2018","journal-title":"J Vestib Res."},{"key":"B12","doi-asserted-by":"publisher","first-page":"2220","DOI":"10.1161\/01.STR.25.11.2220","article-title":"Improved reliability of the NIH Stroke Scale using video training. 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