Clinical and imaging predictors of cerebrovascular stroke in patients with acute isolated dizziness/vertigo: a retrospective cohort study

Background Acute isolated dizziness/vertigo represents a significant diagnostic challenge, as it can be the sole manifestation of posterior circulation stroke. This study aimed to identify clinical and imaging features associated with stroke in a specific high-risk subgroup: patients hospitalized for this complaint despite a normal neurological screening exam. Methods We conducted a retrospective cohort study of patients admitted to the neurology department with acute isolated dizziness/vertigo and a National Institutes of Health Stroke Scale (NIHSS) score of 0. After applying inclusion/exclusion criteria, 437 patients were analyzed. The cohort was divided into stroke ( n = 56) and non-stroke ( n = 381) groups based on neuroimaging. Univariate and multivariate analyses were performed to identify factors independently associated with a final diagnosis of stroke. Results Multivariate analysis identified male sex (odds ratio [OR] = 2.52, 95% confidence interval [CI]: 1.19–5.31, p = 0.016), patient-reported gait impairment (unsteadiness: OR = 5.03, 95% CI: 2.36–10.75, p < 0.001; inability: OR = 5.78, 95% CI: 2.09–16.00, p = 0.001), vertebrobasilar stenosis (OR = 2.00, 95% CI: 1.04–3.84, p = 0.038), and vertebrobasilar dolichoectasia (OR = 10.35, 95% CI: 1.44–74.53, p = 0.020) as factors independently associated with stroke. The ABCD² score did not differ significantly between groups ( p = 0.198). Conclusions In patients hospitalized for acute isolated dizziness/vertigo, male sex, patient-reported gait impairment, and vertebrobasilar artery stenosis are robust factors associated with a final diagnosis of stroke. Vertebrobasilar dolichoectasia also demonstrated a strong association, warranting further validation. These readily accessible features provide practical diagnostic biomarkers for risk stratification in this inpatient population.