Effect of vestibular symptoms on balance and walking function in patients with acute brain stem infarction

Objective To investigate the correlation between vestibular symptoms and balance/ walking function in patients with acute brain stem infarction. Methods Fifty-one patients with acute brain stem infarction with a Functional Ambulation Category Scale (FAC) grade > 3 admitted to Tianjin Huanhu Hospital between November 2023 and December 2024 were included. The subjective visual vertical skew angle was measured using the Bucket Test. The degree of dizziness/vertigo was evaluated by the Visual Analogue Scales (VAS). The vestibulo‐ocular reflex function was assessed by dynamic visual acuity (DVA). The Activities‐Specific Balance Confidence Scale (ABC) was used to evaluate the balance confidence during performing various tasks, and the Dynamic Gait Index (DGI) was applied to assess the objective dynamic balance function. Results Spearman rank correlation analysis showed that the ABC score was negatively correlated with the subjective visual vertical skew angle (rs=-0.414, P=0.003) and dizziness/vertigo VAS score (rs =-0.463, P=0.000), and the DGI index was negatively correlated with subjective visual vertical skew angle (rs=-0.347, P=0.012), dizziness/vertigo VAS score (rs =-0.472, P=0.000) and the number of rows lost in the yaw plane of DVA (rs=-0.326, P=0.019). Multifactor linear stepwise regression analysis showed that the strength of the effect of dizziness/vertigo VAS score (standardized partial regression coefficient=-0.593, P=0.000) on ABC score was approximately 2.21 times greater than that of the subjective visual vertical skew angle (standardized partial regression coefficient=-0.268, P=0.015); the effect of dizziness/vertigo VAS score (standardized partial regression coefficient=-0.666, P=0.000) was 2.53 times stronger on the DGI index than the number of rows lost in the yaw plane of DVA (standardized partial regression coefficient=-0.263, P=0.010). Further Spearman rank correlation analysis showed a positive correlation between dizziness/vertigo VAS score and the proportion of the stance phase time of gait parameter (rs =0.289, P=0.039). Conclusions Dynamic balance function in patients with acute brain stem infarction is mainly affected by the dizziness/vertigo severity. Furthermore, the degree of dizziness/vertigo shows a positive correlation with the proportion of stance phase duration during walking, which warrants heightened attention from both clinicians and rehabilitation therapists.