Distinct phenotype of isolated dizziness stroke: association with cerebellar infarctions and elevated LDL-C

Background Distinguishing ischemic stroke in patients presenting with isolated dizziness or vertigo (IDV) from more benign causes remains a significant clinical challenge. Current understanding of the specific clinical and imaging characteristics that differentiate IDV strokes from strokes with non-isolated symptoms (NIDV) is incomplete. Objective This study aimed to systematically compare the clinical characteristics, with a specific focus on infarction topography and lipid profiles, between patients with acute cerebral infarction presenting with IDV and those with NIDV. Methods In this retrospective cohort study, we analyzed 136 patients with Magnetic Resonance Imaging (MRI)-confirmed acute cerebral infarction who presented with dizziness/vertigo. Patients were classified into IDV ( n = 53; NIHSS = 0, no focal deficits) and NIDV ( n = 83; NIHSS0 or focal deficits) groups based on a standardized neurological assessment. A comprehensive comparison of clinical characteristics was performed, including demographics, vascular risk factors, fasting lipid profiles, and neuroimaging features. Differences between groups were assessed using univariate analyses (Student’s t -tests, Chi-square tests, etc.), with variables significant at p 0.10 eligible for inclusion in a multivariate logistic regression model to identify factors independently associated with the stroke phenotype (IDV vs. NIDV). Results Univariate analysis revealed that the primary differences between groups lay in infarction topography and lipid profiles. Specifically, infarctions in the cerebellar hemisphere (47.2% vs. 25.3%; p = 0.009) and other cerebellar regions (18.9% vs. 4.8%; p = 0.009) were significantly more prevalent in the IDV group, whereas pontine infarctions were strongly associated with the NIDV group (13.2% vs. 41.0%; p = 0.001). Concurrently, the IDV group exhibited a more atherogenic lipid profile, with significantly higher levels of low-density lipoprotein cholesterol (LDL-C) (3.07 ± 0.89 vs. 2.71 ± 0.75 mmol/L, p = 0.013). Notably, the prevalence of acute lacunar infarcts was also higher in the IDV group (17.0% vs. 4.8%, p = 0.019). A history of hypertension was less prevalent in the IDV group (60.4% vs. 83.1%, p = 0.003), though this association was attenuated in the multivariate model ( p = 0.052). In the multivariate model, pontine infarction remained a strong negative predictor of the IDV phenotype (adjusted OR = 0.30, p = 0.016), while a higher LDL-C level emerged as an independent positive predictor (adjusted OR = 1.67 per mmol/L, p = 0.036). Conclusion In patients with confirmed acute cerebral infarction, those presenting with isolated dizziness/vertigo (IDV) represent a distinct phenotype characterized by a predisposition to cerebellar infarctions and a higher atherogenic lipid burden, specifically elevated LDL-C. These findings challenge the notion of a benign underlying vasculopathy in IDV stroke and underscore the necessity of comprehensive vascular assessment, including lipid profiling, in this patient population.