Chronic vertigo and dizziness signal unmet needs in stroke recovery

Abstract

Introduction: Health-related quality of life (HRQoL) in stroke survivors often remains impaired. Chronic vertigo and dizziness are common but frequently overlooked symptoms. We investigated their impact on HRQoL and characterized symptom patterns. Patients and methods: Patients from a prospective stroke cohort study were assessed during hospitalization and followed up after three and twelve months. We evaluated functional outcomes using the modified Rankin Scale (mRS) and National Institute of Health Stroke Scale (NIHSS), and measured HRQoL with the Stroke Impact Scale (SIS). The relationship between vertigo and dizziness and the HRQoL measures was analyzed by multivariable-adjusted regression models. Subgroup analyses were performed for pre-existing and new vertigo or dizziness after stroke. Results: Of 1785 patients enrolled (mean age 69 years; 42.7% female), 988 (55%) completed the 12 months follow-up. Here, 41% reported chronic vertigo or dizziness. These symptoms significantly impacted health-related quality of life across SIS domains, with strongest effects in participation (ß = −11.45 (new-onset)), mobility (ß = −10.26 (preexisting)), and memory (ß = −12.80 (unspecified)), independent of age, sex, stroke severity, and comorbidities. Patients with new-onset symptoms showed higher rehabilitation participation compared to asymptomatic patients (64.3% vs 48.3%, p = 0.001), despite similar stroke severity (mRS: median 2 [IQR 1–3] vs 2 [1–3], p = 0.137; NIHSS: median 2 [IQR 0–4] vs 1 [0–4], p = 0.951). Discussion: Patient-reported vertigo and dizziness after acute stroke are common symptoms that impact HRQoL. Current poststroke care inadequately addresses these symptoms. Conclusion: Early identification, systematic assessment, and targeted interventions are needed.