Acute vestibulopathy

Acute vestibulopathy is characterized by the acute or subacute onset of vertigo, dizziness or imbalance with or without ocular motor, sensory, postural or autonomic symptoms and signs, and can last for seconds to up to several days. Acute vestibular lesions may result from a hypofunction or from pathological excitation of various peripheral or central vestibular structures (labyrinth, vestibular nerve, vestibular nuclei, cerebellum or ascending pathways to the thalamus and the cortex). This update focuses on new aspects of the aetiology, pathophysiology, epidemiology, and treatment of (i) acute peripheral disorders (benign paroxysmal positioning vertigo, vestibular neuritis, Menière's disease, perilymph fistula, especially 'superior canal dehiscence syndrome', vestibular paroxysmia); and (ii) acute central vestibular disorders (especially 'vestibular migraine'). Finally, the clinical relevance of recent diagnostic tools (three-dimensional analysis of eye movement, imaging techniques) is discussed.