Acute Imbalance Syndrome vs Acute Vestibular Syndrome: Clinical and Topographical Differentiation

AND OBJECTIVES: Stroke is a major differential diagnosis in patients with acute vertigo/dizziness or imbalance. Current diagnostic algorithms such as head impulse test, gaze-evoked nystagmus, and test of skew are optimized for presentations with spontaneous nystagmus (SPN), traditionally called acute vestibular syndrome (AVS)....

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Audiologists and vestibular specialists should recognize that acute imbalance syndrome and acute vestibular syndrome have distinct clinical and imaging profiles — understanding these criteria supports timely stroke-risk triage and appropriate referral to neurology.

Accurately distinguishing central (brain-based) from peripheral (inner-ear-based) causes of acute dizziness is critical for preventing delayed stroke diagnosis, a known driver of morbidity and mortality.

1. 01Neurology study differentiates acute imbalance syndrome (central/brain cause) from acute vestibular syndrome (inner-ear cause).
2. 02Clinical signs and topographical (brain location) criteria are proposed to guide differentiation.
3. 03Correct diagnosis helps identify stroke early and avoid misattributing symptoms to inner-ear disease.
4. 04Has direct implications for vestibular assessment protocols and emergency referral pathways.
5. 05Published in Neurology, a high-impact peer-reviewed journal.

PMID

42848973

DOI

10.1212/WNL.0000000000218624.

Journal

Neurology

Publication type

research_article

Evidence level

2b

Population

Patients presenting with acute vertigo, dizziness, or imbalance evaluated for central versus peripheral etiology

Intervention

Clinical and topographical differentiation criteria for acute imbalance syndrome vs. acute vestibular syndrome

Comparator

Acute vestibular syndrome (peripheral/inner-ear cause)