Home›Neurology› Infratentorial lesions result in 58% dizziness prevalence in acute ischemic stroke patients
Infratentorial lesions result in 58% dizziness prevalence in acute ischemic stroke patientsBrain Mapping Reveals Links Between Stroke Location and Dizziness
Journal of neurologyPublished August 13, 2026Study authors: Tang Yunyou, Temuulen Uchralt, Rios Ana Sofia, Khalil Ahmed, Ahmadi Michael, Horn Andreas, Endres Ma…PubMed ↗NCT01586702 ↗DOI ↗Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain
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Key Takeaway
Note that dizziness is more prevalent in ischemic stroke patients with infratentorial lesions (58%) than supratentorial ones.
This retrospective analysis of an RCT evaluated 484 patients with acute ischemic stroke to identify the neuroanatomical substrates of post-stroke dizziness and vertigo. MRI scans were performed within seven days of symptom onset to map lesion locations and connectivity.
Among the cohort, 32% (157/484) reported dizziness at stroke onset. Dizziness was significantly more frequent in patients with infratentorial lesions (58%, 80/137) compared to those with supratentorial lesions (22%, 77/347). Additionally, dizziness was more frequently reported by females (36.9% vs. 27.8%, p = 0.042). Patients presenting with dizziness also showed a higher prevalence of hemianopia (35.1% vs. 15.6%, p < 0.0001).
Lesion symptom mapping identified specific cerebellar clusters associated with visuospatial and multisensory processing, including left lobules VI, Crus I-II, VIIb, VIIIa, and bilateral lobule IX with the vermis. Lesion network mapping identified dizziness network components in left-dominant cerebellar regions, the brainstem, and higher-order visual areas such as the occipital pole, lingual gyrus, and fusiform gyrus.
As a retrospective analysis of an RCT, these findings are observational and indicate associations between lesion location and symptoms. The study did not report specific safety data or adverse events. These results may help guide future diagnostic evaluations for patients experiencing post-stroke dizziness.
Researchers analyzed data from 484 patients who experienced an acute ischemic stroke. The study looked at why some patients experience dizziness or vertigo immediately after a stroke. They found that about 32% of these patients reported feeling dizzy at the start of their symptoms.
The study highlights a strong link between where the brain damage occurs and the presence of dizziness. Patients with injuries in the infratentorial region (the lower part of the brain) were much more likely to experience dizziness compared to those with supratentorial lesions. Additionally, the data showed that women were more likely than men to report dizziness following a stroke.
Because this was a retrospective analysis of existing trial data, the results show associations rather than direct causes. These findings may help doctors better understand how specific brain networks affect balance and vision after a stroke. While these results are helpful for future research, they do not change immediate clinical treatments.
What this means for you:
Stroke location and specific brain networks are linked to dizziness in about one-third of patients.
Common questions
How common is dizziness after a stroke?
In this study of 484 patients, approximately 32% (157 out of 484) reported experiencing dizziness at the time of their stroke onset.
Does the location of the brain injury affect symptoms?
Yes, there is a link between location and symptoms. Patients with infratentorial lesions had a much higher rate of dizziness (58%) compared to those with supratentorial lesions (22%).
Are there specific groups more likely to experience dizziness?
The study found that dizziness was reported more frequently in female patients (36.9%) than in male patients (27.8%). Additionally, patients with dizziness were more likely to have vision issues like hemianopia.
Dizziness and vertigo are common and debilitating neurological symptoms among patients visiting the emergency department (ED). Possibly because the symptoms are not captured by standard stroke severity tools such as the NIHSS (National Institutes of Health Stroke Scale), their network-level neuroanatomical correlates-particularly potential supratentorial contributions-remain incompletely characterized. Therefore, we aim to investigate the neuroanatomical substrates of post-stroke dizziness and vertigo. This retrospective analysis included patients with acute ischemic stroke from the randomized controlled INSPiRE-TMS trial. Each patient underwent MRI within seven days of symptom onset, and stroke severity was assessed using the NIHSS at hospital admission. Patients were assessed for broadly defined new-onset dizziness/vertigo associated with the acute cerebrovascular event. Lesion symptom mapping (LSM) and lesion network mapping (LNM) were used to investigate associations between lesion location, functional connectivity, and dizziness/vertigo. Among 484 patients, 32% (n = 157) reported dizziness at stroke onset. Notably, dizziness was reported in 22% (77/347) of patients with supratentorial lesions, compared with 58% (80/137) of those with infratentorial lesions. Patients with dizziness were more often female (36.9% vs. 27.8%, p = 0.042) and more frequently had hemianopia (35.1% vs. 15.6%, p < 0.0001). LSM identified cerebellar clusters (left lobules VI, Crus I-II, VIIb, VIIIa, and bilateral lobule IX with the vermis) associated with visuospatial and multisensory processing. LNM revealed a dizziness network involving left-dominant cerebellar regions, the brainstem, and higher-order visual areas, including the occipital pole, lingual gyrus, and fusiform gyrus. This network remained robust across subgroups stratified by lesion location (supra- vs. infratentorial) and after adjusting for age, sex, lesion volume, and hemianopia. Exploratory subtype comparisons suggested that lesions associated with vertigo showed relatively stronger connectivity to midline cerebellar structures (vermis), whereas those associated with swaying dizziness involved broader cerebellar hemispheres, although the overall network pattern was spatially similar and centered on the cerebellum. In conclusion, broadly defined post-stroke dizziness/vertigo symptoms were associated with a consistent lesion network involving cerebellar and occipital regions, suggesting involvement of distributed visual, vestibular, and multisensory brain systems. These findings may help guide future studies aimed at improving diagnostic evaluation and treatment of affected patients. ClinicalTrials.gov (NCT01586702; https://clinicaltrials.gov/ct2/show/NCT01586702 ); first registry in April 2012; first patient recruitment: September 2011.
