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Updated: Oct 25, 2025

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Acute Vestibular Syndrome.

Kristen K Steenerson

    Continuum (Minneapolis, Minn.)
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    This summary is machine-generated.

    Acute vestibular syndrome requires prompt diagnosis to differentiate between benign causes and stroke. Clinical examination, including the HINTS Plus exam, is crucial for accurate diagnosis and guiding treatment with physical therapy.

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    Area of Science:

    • Neurology
    • Ophthalmology
    • Otolaryngology

    Background:

    • Acute vestibular syndrome presents as sudden, continuous vertigo, nausea, and vomiting, exacerbated by head movement.
    • Common causes include vestibular neuritis and posterior circulation stroke.
    • Overlapping symptoms between central and peripheral vestibular disorders necessitate careful diagnostic evaluation.

    Purpose of the Study:

    • To provide a practical approach to diagnosing acute vestibular syndrome.
    • To highlight recent research advances in understanding and managing this condition.
    • To emphasize the importance of clinical examination over early neuroimaging.

    Main Methods:

    • Clinical assessment focusing on symptom timing, patient history, and ocular motor findings.
    • Utilizing the HINTS Plus (Head Impulse test, Nystagmus, Test of Skew with Plus hearing loss assessment) examination.
    • Comprehensive neurologic examination to differentiate central from peripheral causes.

    Main Results:

    • Clinical examination, particularly HINTS Plus, demonstrates higher sensitivity and specificity than early neuroimaging for diagnosing stroke.
    • Distinguishing between central (e.g., stroke) and peripheral (e.g., vestibular neuritis) causes is critical.
    • Early identification of stroke is vital due to potential for cerebellar herniation.

    Conclusions:

    • A systematic clinical approach, including HINTS Plus, improves diagnostic accuracy for acute vestibular syndrome.
    • While often benign, stroke must be considered in all cases.
    • Vestibular physical therapy is the primary treatment modality for recovery, with limited evidence for long-term medication use.