Background: Diagnosing stroke as a cause of acute vertigo, dizziness, or double vision remains a challenge, because symptom characteristics can be variable. The purpose of this study was to prospectively investigate lesion-symptom relationships in patients with acute vestibular or ocular motor stroke. Methods: Three hundred and fifty one patients with acute and isolated vestibular or ocular motor symptoms of unclear etiology were enrolled in the EMVERT lesion trial. Symptom quality was assessed by the chief complaint (vertigo, dizziness, double vision), symptom intensity by the visual analog scale, functional impairment by EQ-5D-5L, and symptom duration by daily rating. Acute vestibular and ocular motor signs were registered by videooculography. A standardized MRI (DWI-/FLAIR-/T2-/T2*-/3D-T1-weighted sequences) was recorded within 7 days of symptom onset. MRIs with DWI lesions were further processed for voxel-based lesion-symptom mapping (VLSM). Results: In 47 patients, MRI depicted an acute unilateral stroke (13.4%). The chief complaints were dizziness (42.5%), vertigo (40.4%) and double vision (17.0%). Lesions in patients with vertigo or dizziness showed a large overlap in the cerebellar hemisphere. VLSM indicated that strokes in the medial cerebellar layers 7b, 8, 9 were associated with vertigo, strokes in the lateral cerebellar layer 8, crus 1, 2 with dizziness, and pontomesencephalic strokes with double vision. Symptom intensity and duration varied largely between patients. Higher symptom intensity and longer duration were associated with medial cerebellar lesions. Hemispheric lesions of the cortex were rare and presented with milder symptoms of shorter duration. Conclusions: Prospective evaluation of patients with acute vestibular or ocular motor stroke revealed that symptom quality, intensity and duration were not suited to differentiating peripheral from central etiologies. Lesions in the lateral cerebellum, thalamus, or cortex presented with unspecific, mild and transient symptoms prone to being misdiagnosed.

中文翻译：

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急性前庭和眼运动中风的病变-症状关系的前瞻性分析。

背景：中风是急性眩晕，头晕或复视的原因，因此诊断仍然很困难，因为症状特征可能会有所不同。本研究的目的是前瞻性研究急性前庭或眼部运动性卒中患者的病变-症状关系。方法：351例病因不明的急性和孤立性前庭或眼部运动症状的患者参加了EMVERT病变试验。通过主诉评估症状质量（眩晕，头晕，复视），通过视觉模拟量表评估症状强度，通过EQ-5D-5L评估功能障碍，并通过每日评分评估症状持续时间。通过眼动摄影术记录了急性前庭和眼部运动征象。在症状发作的7天内记录了标准MRI（DWI- / FLAIR- / T2- / T2 *-/ 3D-T1加权序列）。具有DWI病变的MRI会进一步处理，以进行基于体素的病变症状标测（VLSM）。结果：在47例患者中，MRI表现为急性单侧中风（13.4％）。主要的抱怨是头晕（42.5％），眩晕（40.4％）和复视（17.0％）。眩晕或头晕患者的病变在小脑半球出现大量重叠。VLSM指出，小脑内侧7b，8、9的中风与眩晕有关，小脑外侧8，crus 1、2的中风与头晕有关，双眼的脑脑卒中。患者之间的症状强度和持续时间差异很大。较高的症状强度和较长的持续时间与内侧小脑病变有关。大脑皮层的半球病变很少见，表现出持续时间较短的轻微症状。结论：对急性前庭或眼部运动性卒中患者的前瞻性评估表明，症状质量，强度和持续时间不适合区分周围病因和中央病因。小脑外侧，丘脑或皮层的病变表现出非特异性，轻度和短暂的症状，容易被误诊。