Poststroke chronic vertigo and dizziness require individualized rehabilitation

The significantly poorer health-related quality of life (HRQoL) in patients with chronic vertigo and dizziness compared with those without, following a stroke, necessitates systematic poststroke screening, comprehensive multidisciplinary assessment and individualized rehabilitation, according to a stroke cohort study.

The prospective study included 1,785 eligible patients (mean age, 69 years; female, 42.7 percent) with ischaemic or haemorrhagic strokes or transient ischaemic attacks admitted to the University Hospital of Augsburg between September 2018 and May 2022. The patients were assessed during hospitalization and followed up after 3 and 12 months. [J Neurol 2025;doi:10.1007/s00415-025-13562-7]

Of this initial cohort, 988 (55 percent) completed 12-month follow-up, out of which 41 percent reported chronic vertigo or dizziness. Of these symptomatic patients, 136 were new-onset (poststroke) cases, while 171 had such symptoms prior to the index event (pre-existing) and 94 were unspecified. Patients with pre-existing symptoms were notably older than those with poststroke onset or no symptoms.

Symptoms were assessed using structured interviews during follow-up visits. Patients were asked whether they experienced dizziness, followed by characterization of symptom type, triggers, accompanying symptoms, duration, and frequency (days per month). Based on the patients’ responses, symptoms were categorized as vertigo (rotational or rocking/swaying sensations) or dizziness (gait instability or light-headedness), keeping in view that the latter may have multiple potential aetiologies including nonneurological causes, such as cardiovascular or medication-related effects. Chronic symptoms were defined as those persisting at the 12-month follow-up, regardless of frequency – this definition would capture patients with ongoing symptom burden, including those with episodic but recurrent symptoms (median frequency, 10 days per month for both vertigo and dizziness).

Follow-up evaluations included patient-reported functional outcome (modified Rankin Scale [mRS], range 0–4) and quality of life after stroke assessed using the Stroke Impact Scale (SIS), which measures eight domains: strength, hand function, activities of daily living, mobility (eg, walking, stair climbing, transferring), communication, emotion, memory (eg, remembering information, concentration, thinking), and participation (eg, work, recreational activities, helping others).

At 12 months, patients without vertigo or dizziness had significantly better functional outcomes than all symptomatic groups (poststroke, p_adj=3.5 x 10⁻¹⁷; pre-existing, p_adj=2.5 x 10⁻¹⁰; unspecified, p_adj=5.8 x 10⁻⁷). Among symptomatic patients, those with poststroke symptom onset reported worse functional outcomes compared with those who had such pre-existing symptoms (p_adj=0.023). Notably, this poorer functional outcome occurred despite a higher rehabilitation participation rate among those with poststroke symptoms compared with those without such symptoms (64.3 vs 48.3 percent; p=0.001), and despite similar stroke severity.

In symptomatic patients, the most severe impairment was in the participation domain (β=-11.45) for those with poststroke-onset symptoms, in the mobility domain (β=-10.26) for those with pre-existing symptoms, and in the memory domain (β=-12.80) for those in the unspecified category, independent of age, sex, stroke severity, and comorbidities.

“HRQoL in stroke survivors often remains impaired. Chronic vertigo and dizziness are common but frequently overlooked symptoms,” stated the authors. “The paradoxical finding of poorer outcomes despite higher rehabilitation participation reveals gaps in current poststroke care, highlighting the need for systematic screening, comprehensive multidisciplinary assessment, and individualized rehabilitation to address this often-overlooked symptom burden in stroke survivors,” they concluded.