Are We Making Progress in the Evaluation of Acute Vertigo?

When a patient presents with acute vestibular syndrome (AVS), the primary responsibility of the examiner is to determine, as best as possible, whether this represents a worrisome pathology such as a posterior fossa stroke. While the vast majority of patients presenting with AVS will ultimately be found to have peripheral vestibular disorders, this does not undermine the importance of performing fast and efficient...

Audiologists and clinicians evaluating acute dizziness should be aware of the HINTS exam (Head-Impulse, Nystagmus, Test-of-Skew) and current best-evidence approaches for ruling out posterior fossa stroke, though scope-of-practice limits mean urgent medical referral protocols remain the primary action.

Misdiagnosis of posterior fossa stroke as benign vertigo in the acute setting carries serious patient-safety consequences, making updated evaluation frameworks critically important for any clinician who encounters acute dizziness.

1. 01Acute vestibular syndrome (AVS) — sudden, persistent severe dizziness — can stem from either a benign inner-ear cause or a life-threatening stroke.
2. 02Differentiating central (brain) from peripheral (inner-ear) causes is the core clinical challenge in AVS evaluation.
3. 03The HINTS bedside exam (Head-Impulse, Nystagmus, Test-of-Skew) is highlighted as a key diagnostic tool.
4. 04Posterior fossa stroke can be missed on early CT imaging, making clinical examination skills especially important.
5. 05Article reflects on whether progress in acute vertigo evaluation has kept pace with clinical need.