Prospective quantitative evaluation of gait and stance in patients with acute vertigo and dizziness

Patients with acute vertigo and dizziness often suffer from gait ataxia and postural imbalance. However, detailed and quantitative investigations of gait and stance are largely missing during the acute stage of symptoms.

This study explores whether assessing objective gait and stance parameters can help differentiate between peripheral and central causes of isolated acute vertigo and dizziness. Patients underwent a standardized protocol within the EMVERT study at the emergency department of LMU University Hospital during the acute stage (on average at 16 h after symptom onset), which included the Timed Up and Go test (TUG), Functional Gait Assessment (FGA), Gait and Truncal Ataxia Index (GTI) and mobile posturography. Patients were categorized into three groups: Acute vestibular strokes (n = 56), acute unilateral vestibulopathy (AUVP, n = 52) and episodic vestibular disorders (n = 92). Outcomes were analyzed using logistic regression models and ROC curves adjusted for age and sex.

We found that patients with AUVP exhibited worse TUG, FGA and GTI scores than those with vestibular strokes or episodic vestibular disorders. ROC curves for TUG, FGA and GTI showed a weak diagnostic accuracy (0.57-0.62) for stroke versus AUVP, which only improved (to 0.75-0.82), if corrected for age and gender. Posturographic sway path was lowest for episodic vestibular disorders, but similar for stroke and AUVP.

Clinical gait and stance tests such as TUG, FGA and GTI do not reliably differentiate central from peripheral etiologies of isolated acute vertigo and dizziness in patients with a mild to moderate burden of symptoms.