title: Acute vestibular syndrome: a critical review and diagnostic algorithm concerning the clinical differentiation of peripheral versus central aetiologies in the emergency department.
abstract: Almost 20 % of cerebral ischaemic strokes occur in the posterior circulation. Estimates are that 20 % of these patients present with isolated vertigo. In approximately one-sixth to one-third of these patients, this symptom is wrongly diagnosed to be peripheral vestibular in origin. As a result, these missed stroke patients are withheld from therapeutic and secondary prophylactic treatment, which may result in unnecessary morbidity and mortality. We therefore propose a diagnostic algorithm concerning the clinical differentiation of acute vestibular syndrome (AVS) patients based on a critical review of the available literature.
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Albert Schweitzer Hospital, PO Box 444, 3300, Dordrecht, The Netherlands. j.venhovens@hotmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Venhovens
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Meulstee
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: W I M
authors.initials: WI
authors.lastname: Verhagen
mesh_terms: D000465:Algorithms; D002493:Central Nervous System Diseases / Q000150:complications*; D004636:Emergency Service, Hospital; D006801:Humans; D010523:Peripheral Nervous System Diseases / Q000150:complications*; D015837:Vestibular Diseases / Q000175:diagnosis* / Q000209:etiology*
keywords: Acute vestibular syndrome (AVS); HINTS; Head impulse test (HIT); Vertebrobasilar stroke; Vertigo