The TriAge+ Score as an Initial Clinical Diagnostic Tool for Central Vertigo in Cerebellar Stroke – A Case Report
Case Report
DOI:
https://doi.org/10.55175/cdk.v53i07.1706Keywords:
Case report, cerebellum, TriAge score, infarct stroke, vertigoAbstract
Introduction: Vertigo is a common complaint in the emergency department (ED); however, differentiating central from peripheral vertigo remains challenging. More than 4.4 million patients present to the emergency department annually with dizziness or vertigo, and approximately 5% are diagnosed with stroke. Early identification of central vertigo is crucial to prevent adverse neurological outcomes. Case: A 63-year-old male presented with severe swaying dizziness accompanied by nausea, rendering him unable to walk. The TriAge+ score was 9, indicating high risk for stroke. On the fourth day of hospitalization, the patient developed weakness in the right extremities and impaired sensory function in the bilateral cranial nerve V distribution. Non-contrast head CT revealed a subacute ischemic cerebral infarction affecting the pons, right corona radiata, and bilateral basal ganglia, with signs of brain atrophy. The patient was diagnosed with central vertigo due to cerebellar infarct stroke. Discussion: The TriAge+ score demonstrates high sensitivity for detecting central vertigo in the ED. In resource-limited settings where neuroimaging is not immediately available, this bedside clinical tool can facilitate early risk stratification and timely referral for definitive diagnostic workup and stroke-specific care. Conclusion: The TriAge+ score, as an early clinical diagnostic tool in the ED, is essential for detecting central vertigo in order to reduce morbidity and mortality associated with cerebellar stroke.
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References
WHO. World health statistics overview 2019: monitoring health for the SDGs, sustainable development goals [Internet]. Geneva: World Health Organization; 2019. Available from: https://www.who.int/publications/i/item/9789241565707.
Kementerian Kesehatan RI. Laporan nasional RISKESDAS 2018 [Internet]. Jakarta: Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan; 2018. Available from: https://repository.kemkes.go.id/book/1323.
Saber Tehrani AS, Kattah JC, Kerber KA, Gold DR, Zee DS, Urrutia VC, et al. Diagnosing stroke in acute dizziness and vertigo. Stroke. 2018;49(3):788–95. doi: 10.1161/STROKEAHA.117.016979.
Wright J, Huang C, Strbian D, Sundararajan S. Diagnosis and management of acute cerebellar infarction. Stroke. 2014;45(4):e56–8. doi: 10.1161/STROKEAHA.114.004474.
Bodranghien F, Bastian A, Casali C, Hallett M, Louis ED, Manto M, et al. Consensus paper: revisiting the symptoms and signs of cerebellar syndrome. Cerebellum. 2016;15(3):369–91. doi:10.1007/s12311-015-0687-3.
Kuroda R, Nakada T, Ojima T, Serizawa M, Imai N, Yagi N, et al. The TriAGe+ score for vertigo or dizziness: a diagnostic model for stroke in the emergency department. J Stroke Cerebrovasc Dis. 2017;26(5):1144–53. doi: 10.1016/j.jstrokecerebrovasdis.2017.01.009.
Sari DA, Sutarni S, Setyopranoto I. Stroke iskemik dengan manifestasi dizziness/vertigo terisolasi. Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia. 2020;37(2):116–24. doi: 10.52386/neurona.v37i2.116.
Sutarni S, Malueka RG, Gofir A. Bunga rampai vertigo [Internet]. Yogyakarta: Gadjah Mada University Press; 2019. Available from: https://digitalpress.ugm.ac.id/book/11.
Miao HL, Zhang DY, Wang T, Jiao XT, Jiao LQ. Clinical importance of the posterior inferior cerebellar artery: a review of the literature. Int J Med Sci. 2020;17(18):3005–19. doi: 10.7150/ijms.49137.
Zwergal A, Feil K, Schniepp R, Strupp M. Cerebellar dizziness and vertigo: etiologies, diagnostic assessment, and treatment. Semin Neurol. 2020;40(1):87–96. doi: 10.1055/s-0039-3400315.
Salerno A, Strambo D, Nannoni S, Dunet V, Michel P. Patterns of ischemic posterior circulation strokes: a clinical, anatomical, and radiological review. Int J Stroke. 2022;17(7):714–22. doi:10.1177/17474930211046758.
Miao HL, Zhang DY, Wang T, Jiao XT, Jiao LQ. Clinical importance of the posterior inferior cerebellar artery: a review of the literature. Int J Med Sci. 2020;17(18):3005–19. doi: 10.7150/ijms.49137.
Rahmadita R, Shafa GN, Laksono S. Elektogram intrakardiak pada atrial flutter. Human Care Journal. 2022;7(3):565. doi: 10.32883/hcj.v7i3.1984.
Dommaraju S, Perer E. An approach to vertigo in general practice. Aust Fam Physician. 2016 Apr;45(4):190–4. PMID: 27052132.
Zwergal A, Dieterich M. Vertigo and dizziness in the emergency room. Curr Oppin Neurol. 2020;33(1):117–25. doi: 10.1097/WCO.0000000000000769.
Putra IBK, Adrian F. Dizziness dan vertigo dengan kerterkaitan sistem vertebrobasiler. Callosum Neurology. 2019;2(1):19–27. doi: 10.29342/cnj.v2i1.56.
Rosyidi RM, Priyanto B. Cerebellar infarction complicated with acute hydrocephalus. Int J Res Med Sci. 2019;7(3):948. doi: 10.18203/2320-6012.ijrms20190955.
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