The epidemiology and clinical presentation of acute vestibular syndromes: a systematic review of the literature.

BACKGROUND

Acute vertigo and dizziness are among the most frequent complaints presenting to the emergency department (ED). If acute-onset and persistent vertigo/dizziness (lasting > 24 h) are accompanied by motion intolerance, gait imbalance, nausea/vomitus, and (usually also) nystagmus, this refers to the acute vestibular syndrome (AVS). We aimed at collecting epidemiologic data about the frequency of AVS etiologies for improving the diagnostic workup.

METHODS

We conducted a Prospero-registered systematic literature search (MEDLINE, Embase - in June 2024) retrieving information on AVS's clinical presentation, differential diagnosis, and stroke frequency. Two independent reviewers screened abstracts and full texts. Studies were rated with QUADAS-2 for risk of bias. Due to heterogeneity, we refrained from meta-analysis.

RESULTS

We identified 6731 unique articles and 45 manuscripts (reporting on > 5 Mio. dizzy patients) that were included. 3.45% of all ED visits were related to dizziness/vertigo. One tenth (i.e., 0.3%) met the diagnostic criteria for an AVS. Only about 74% of AVS patients received peripheral or central vestibular diagnoses, while 26% were non-specific. Stroke was the second most common cause (21% in our dedicated review) after acute unilateral vestibulopathy (38%). Selected studies assessing infarction location showed posterior-inferior cerebellar artery (36%) involvement most commonly. Stroke cases were seen at similar rates in patients with or without nystagmus (22 vs. 25%).

CONCLUSION

Representing 10% of all dizzy patients, AVS in the ED is frequent. With a stroke fraction among all AVS cases of approximately 21%, profound clinical training to differentiate peripheral from central causes reliably should be prioritized.