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Related Experiment Video

Updated: Jan 6, 2026

Using Eye-tracking to Assess the Relative Importance of Visual and Vestibular Input to Subcortical Motion Processing in the Roll Plane
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Using Eye-tracking to Assess the Relative Importance of Visual and Vestibular Input to Subcortical Motion Processing in the Roll Plane

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Acute vertigo: stroke or not?

Diego Kaski1

  • 1SENSE Research Unit, Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK.

Current Opinion in Neurology
|November 20, 2025
PubMed
Summary
This summary is machine-generated.

Acute vertigo, a common emergency department visit cause, often presents diagnostic challenges. A structured bedside approach is crucial for accurate diagnosis and timely treatment of acute vestibular syndrome (AVS) to prevent misdiagnosis of stroke.

Keywords:
acute vertigoacute vestibular syndromedizzinessgait ataxialabyrinthine stroke

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Vestibular Disorders

Background:

  • Acute vertigo is a frequent reason for emergency department visits, yet lacks a standardized care pathway.
  • Acute vestibular syndrome (AVS) presents diagnostic difficulties, with high rates of misdiagnosis, particularly for posterior circulation strokes.
  • Current diagnostic methods, including early neuroimaging, have limitations in accurately identifying stroke within the initial 48 hours.

Purpose of the Study:

  • To review the challenges in diagnosing acute vestibular syndrome (AVS).
  • To highlight the importance of timely recognition of AVS to prevent adverse outcomes.
  • To emphasize the need for improved diagnostic strategies for dizziness and vertigo in emergency settings.

Main Methods:

  • Literature review focusing on differential diagnoses for AVS.
  • Analysis of diagnostic challenges, including limitations of neuroimaging (MRI).
  • Examination of bedside clinical features and targeted examination for AVS.

Main Results:

  • The differential diagnosis for AVS is broad, encompassing benign peripheral and life-threatening central causes.
  • Distinguishing stroke from peripheral vestibular disorders is a significant clinical challenge.
  • A substantial percentage (up to 35%) of posterior circulation strokes presenting with dizziness are initially missed, often by non-specialists.

Conclusions:

  • A structured bedside approach utilizing key clinical features and targeted examination can enhance diagnostic accuracy for AVS.
  • Implementing standardized bedside diagnostic strategies can reduce treatment delays and improve patient outcomes.
  • Addressing the diagnostic gap in acute neurology care for vertigo and dizziness is essential.