Comparative clinical characteristics of patients with vertebrobasilar stroke and its mimics

Background. Acute dizziness is a common reason for emergency department visits, necessitating rapid differential diagnosis between vertebrobasilar stroke (VBS) and benign peripheral vestibulopathies.

Aim: to conduct a comparative clinical analysis of patients with confirmed VBS and conditions mimicking its onset (stroke mimics).

Material and Methods. This single-center retrospective study (2024–2025) included 140 patients divided into two groups: Group 1 comprised patients (n = 84) with neuroimaging-confirmed VBS; Group 2 consisted of patients (n = 56) with stroke mimics (vestibular neuritis — 38%, benign paroxysmal positional vertigo — 36%, other peripheral vestibulopathies — 26%). All patients underwent neurological examination, neuroimaging (CT/MRI), and CT angiography.

Results. The clinical presentation differed between the groups. Stroke mimics were characterized by isolated vertigo, nausea/vomiting, whereas VBS was associated with a combination of truncal ataxia and dysarthria. A cerebral infarct focus was detected on initial CT in only 21.4% of VBS patients; however, follow-up imaging within the first 3 days revealed an additional 62%. Reperfusion therapy was administered to 33% of VBS patients and 11% of those with mimics. Isolated acute vestibular syndrome as a manifestation of VBS was identified in 14% of patients. The central and peripheral vertigo groups did not differ in cardiovascular risk profiles.

Conclusion. Every third case of suspected VBS is a stroke mimic. The low diagnostic yield of initial CT necessitates mandatory follow-up neuroimaging. The significant proportion of thrombolysis administered to patients with mimics underscores the need to implement standardized clinical algorithms at the initial assessment stage to improve diagnostic accuracy and optimize treatment.

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