Vestibular symptom resolution in minor stroke follows a biphasic trajectory with rapid early improvement and slower late recovery, and SVD score ≥2, persistent vestibular symptoms, and anxiety/depression are independent predictors of long-term fall risk.
Key Findings
Results
Vestibular symptom persistence rates in minor stroke patients declined progressively over 12 months following stroke.
Symptom persistence rates declined from 56.20% at discharge to 30.99% at 3 months
Further decline to 26.45% at 6 months and 16.12% at 1-year follow-up
The pattern was described as a 'biphasic trajectory' with rapid early improvement and slower late recovery
Study recruited 242 patients with acute minor stroke presenting vestibular symptoms between September 2021 and December 2022
Results
A total small vessel disease (SVD) score ≥2 was an independent predictor of 1-year fall risk in minor stroke patients with vestibular symptoms.
Odds ratio = 5.106 (95% CI: 1.747–14.921, p = 0.003)
SVD score ≥2 was identified through multivariable logistic regression analysis
The finding highlights the clinical value of early SVD marker identification
SVD burden was assessed as part of a comprehensive longitudinal evaluation at discharge, 3, 6, and 12 months poststroke
Results
Persistent vestibular symptoms were significantly associated with increased risks of both falls and fear of falling (FoF) at 1 year poststroke.
Association was identified via multivariable logistic regression
Vestibular symptom progression was systematically assessed at discharge, 3, 6, and 12 months poststroke
Balance confidence and psychological status were evaluated with standardized instruments at each follow-up
Persistent vestibular symptoms were identified as an independent predictor of long-term fall risk alongside SVD score ≥2, temporal lobe involvement, and anxiety/depression
Results
Anxiety and depression poststroke were significantly associated with increased risks of falls and fear of falling.
Both anxiety and depression were independently associated with increased fall risk and FoF in multivariable regression analysis
Psychological status was evaluated using standardized instruments at each follow-up visit
The findings highlight the importance of regular monitoring of emotional status alongside vestibular function
Anxiety/depression was listed as one of four independent predictors of long-term fall risk
Results
Temporal lobe involvement was identified as an independent predictor of long-term fall risk in minor stroke patients.
Temporal lobe involvement was identified through multivariable logistic regression analysis
It was one of four independent predictors of 1-year fall risk, alongside SVD score ≥2, persistent vestibular symptoms, and anxiety/depression
The study population consisted of 242 patients with acute minor stroke presenting vestibular symptoms
Functional outcomes were quantified using the modified Rankin Scale (mRS)
What This Means
This research followed 242 patients who had mild strokes and were experiencing vestibular symptoms (such as dizziness or balance problems) for up to one year after their stroke. The researchers found that while most patients improved over time, vestibular symptoms did not disappear quickly or uniformly — more than half of patients still had symptoms at hospital discharge, and about 1 in 6 still had symptoms a full year later. The recovery pattern showed fast early improvement followed by a slower, more gradual recovery phase.
The study identified four key factors that predicted whether a patient would fall or develop a fear of falling within the first year: having a high burden of small vessel disease (tiny damage to blood vessels in the brain), having ongoing vestibular symptoms, experiencing anxiety or depression after the stroke, and having the stroke affect the temporal lobe of the brain. In particular, patients with a small vessel disease score of 2 or higher were about five times more likely to experience a fall compared to those with lower scores.
This research suggests that doctors caring for mild stroke patients should routinely check for signs of small vessel disease in the brain, monitor how vestibular symptoms evolve over time, and also assess patients' mental health, since anxiety and depression significantly increase the risk of falling. Rather than focusing only on physical recovery, a more complete approach that tracks both balance function and emotional well-being may help identify patients who need additional fall-prevention support after a mild stroke.
Zhong Y, Jia J, Li J, Jiang R, Zhao X, Ju Y. (2026). Falls and Fear of Falling in Minor Stroke Patients With Vestibular Symptoms: A Longitudinal Observational Study.. Brain and behavior. https://doi.org/10.1002/brb3.71509