{
  "schemaVersion": 2,
  "eyebrow": "Emergency Neurology",
  "title": "Acute Vertigo Evaluation",
  "summary": "Evaluate acute vertigo by syndrome and examination target, not symptom quality. In continuous vestibular symptoms with spontaneous nystagmus, trained HINTS-plus examination can identify central patterns that warrant stroke imaging and management despite an early negative MRI.",
  "seoDescription": "Physician approach to acute vertigo: identify acute vestibular syndrome, apply HINTS-plus correctly, recognize stroke patterns, and use imaging appropriately.",
  "clinicalQuestion": "How should clinicians distinguish posterior circulation stroke from peripheral vestibular disease in acute vertigo?",
  "specialty": "Emergency Medicine and Neurology",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "acute vestibular syndrome",
    "acute vertigo",
    "HINTS examination",
    "HINTS plus",
    "posterior circulation stroke",
    "vestibular neuritis",
    "video head impulse test"
  ],
  "keyTakeaways": [
    "Apply HINTS or HINTS-plus only to acute vestibular syndrome with spontaneous nystagmus; it is not interpretable when nystagmus is absent. [11][13]",
    "Any central HINTS finding—normal head impulse, direction-changing gaze-evoked nystagmus, or skew deviation—should be managed as possible posterior circulation stroke. [9][20][21]",
    "A peripheral-pattern abnormal head impulse does not exclude stroke when new unilateral hearing loss is present or when an AICA, labyrinthine artery, or vestibular nucleus infarct is possible. [1][9]",
    "Do not use a negative MRI obtained within 48 hours as the sole rule-out test for posterior fossa infarction when bedside findings remain central; early MRI may miss 20% to 50% of posterior fossa infarctions. [1][19]",
    "HINTS performance depends on examiner training; routine emergency-department use by untrained clinicians has not reproduced expert-level accuracy. [13]"
  ],
  "sections": [
    {
      "id": "identify-the-vestibular-syndrome",
      "eyebrow": "First Branch Point",
      "heading": "Identify acute vestibular syndrome before ordering a stroke workup",
      "intro": "The examination and imaging strategy depend on timing, persistence, and observed eye findings.",
      "paragraphs": [
        "Use an acute vestibular syndrome (AVS) pathway when dizziness or vertigo is acute in onset, continuous for at least 24 hours, and accompanied by nausea or vomiting, head-motion intolerance, gait unsteadiness, and spontaneous nystagmus. AVS commonly persists for days to weeks and is caused most often by vestibular neuritis but may reflect brainstem or cerebellar ischemia. [3][7][13][16]",
        "Treat AVS as a stroke-risk presentation rather than presuming a peripheral process from severe vertigo, vomiting, or inability to walk alone. Approximately 10% to 20% of spontaneous AVS presentations are stroke, and roughly one-quarter of high-risk AVS cohorts have brainstem or cerebellar stroke. [3][4]",
        "Do not apply HINTS to episodic positional vertigo or to a patient without spontaneous nystagmus. In patients meeting diagnostic criteria for benign paroxysmal positional vertigo (BPPV) without additional vestibular or neurologic findings, routine neuroimaging and additional vestibular testing are not recommended; central features should instead prompt brain MRI or thin-slice CT evaluation. [11][18]"
      ],
      "bullets": [
        "AVS phenotype: continuous symptoms, spontaneous nystagmus, nausea or vomiting, motion intolerance, and unsteady gait. [3][13][21]",
        "Positional/episodic phenotype: use positional assessment for BPPV rather than HINTS; obtain central nervous system imaging only when additional concerning features are present. [18]",
        "Transient vestibular symptoms are not AVS; posterior circulation transient ischemia remains a diagnostic challenge and should not be reassured by an inapplicable HINTS examination. [11]"
      ],
      "subsections": [],
      "table": {
        "caption": "Syndrome selection determines whether HINTS is valid and what a result changes. [11][13][18]",
        "columns": [
          "Presentation pattern",
          "Bedside approach",
          "Immediate implication"
        ],
        "rows": [
          [
            "Continuous acute vertigo or dizziness with spontaneous nystagmus and gait instability",
            "Perform HINTS-plus only if trained in the examination. [11][13]",
            "A central result requires posterior circulation stroke evaluation. [9][20]"
          ],
          [
            "Triggered positional episodes meeting BPPV criteria",
            "Use positional diagnostic assessment; do not use HINTS. [11][18]",
            "Avoid routine imaging unless other signs or symptoms suggest a central cause. [18]"
          ],
          [
            "No spontaneous nystagmus",
            "Do not interpret HINTS-plus. [11]",
            "Use targeted neurologic and vestibular assessment based on the clinical syndrome. [13]"
          ]
        ]
      }
    },
    {
      "id": "perform-hints-plus-correctly",
      "eyebrow": "Bedside Discrimination",
      "heading": "Interpret HINTS-plus as a three-sign central screen",
      "intro": "A single nonperipheral component makes the examination central until proved otherwise.",
      "paragraphs": [
        "In AVS with spontaneous nystagmus, perform horizontal head impulse testing, assess nystagmus in different gaze positions, and use prism cross-cover testing for ocular alignment. Add bedside hearing assessment for HINTS-plus because acute unilateral hearing loss can identify stroke involving arterial supply to the labyrinth. [9][21]",
        "Classify HINTS as central when any component is inconsistent with peripheral vestibular localization: a normal horizontal head impulse without corrective saccade, direction-changing or gaze-evoked nystagmus, or skew deviation. Vertical ocular misalignment on cross-cover testing is always suspicious for central pathology. [9][20]",
        "A peripheral-pattern examination requires an abnormal unilateral head impulse with corrective catch-up saccades, unidirectional nystagmus, and no skew deviation. Unidirectional nystagmus—particularly when following Alexander's law—and catch-up saccades after lateral head impulse typically imply peripheral pathology, but these findings must be interpreted as the complete HINTS pattern rather than in isolation. [20][21]",
        "HINTS-plus increases protection against falsely labeling an AICA or labyrinthine artery infarct as vestibular neuritis. These infarcts can produce unilateral peripheral vestibular dysfunction, including reduced vestibulo-ocular reflex gain and catch-up saccades, on bedside and video head impulse testing. New unilateral hearing loss should therefore override reassurance from an otherwise peripheral-appearing head impulse result. [1][9]"
      ],
      "bullets": [
        "Normal head impulse in AVS: central pattern; evaluate for stroke. [9][20]",
        "Direction-changing nystagmus with gaze: central pattern; evaluate for stroke. [9][20]",
        "Skew deviation on cross-cover testing: central pattern; evaluate for stroke. [9][20]",
        "New unilateral hearing loss: HINTS-plus central warning, including possible labyrinthine ischemia. [1][9]",
        "All peripheral-pattern components must be present before calling the result peripheral. [20]"
      ],
      "subsections": [
        {
          "heading": "Who should perform HINTS",
          "paragraphs": [
            "Reserve HINTS and HINTS-plus for clinicians trained to elicit and interpret the ocular motor findings. Expert studies report high diagnostic performance, but routine emergency clinician use has not achieved the same results; this limits using an untrained examination to defer stroke evaluation. [13][14]",
            "A meta-analysis of 11 HINTS studies reported sensitivity of 0.97 and specificity of 0.81 for stroke; HINTS-plus sensitivity was 0.99 and specificity 0.82. These estimates apply to appropriately selected AVS populations and do not validate use outside the syndrome or without examiner proficiency. [9]"
          ],
          "bullets": []
        }
      ],
      "table": {
        "caption": "HINTS-plus interpretation in acute vestibular syndrome with spontaneous nystagmus. [1][9][20]",
        "columns": [
          "Component",
          "Peripheral-compatible finding",
          "Central warning finding",
          "Action"
        ],
        "rows": [
          [
            "Horizontal head impulse",
            "Corrective catch-up saccade after lateral impulse. [20]",
            "Normal response without corrective saccade. [9][20]",
            "Central finding: pursue posterior circulation stroke evaluation. [9]"
          ],
          [
            "Nystagmus",
            "Unidirectional nystagmus, especially following Alexander's law. [20]",
            "Direction-changing or gaze-evoked nystagmus. [9][20]",
            "Central finding: pursue posterior circulation stroke evaluation. [9]"
          ],
          [
            "Test of skew",
            "No vertical ocular misalignment. [20]",
            "Skew deviation on cross-cover testing. [20]",
            "Central finding: pursue posterior circulation stroke evaluation. [20]"
          ],
          [
            "Hearing in HINTS-plus",
            "No new unilateral hearing loss. [9]",
            "New unilateral hearing loss, including with an abnormal head impulse. [1][9]",
            "Consider AICA/labyrinthine ischemia and manage as possible stroke. [1][9]"
          ]
        ]
      }
    },
    {
      "id": "use-imaging-without-false-reassurance",
      "eyebrow": "Imaging Strategy",
      "heading": "Use MRI to confirm stroke, not to overrule a central bedside examination",
      "intro": "Posterior fossa ischemia may be radiographically occult early after symptom onset.",
      "paragraphs": [
        "For AVS with any central HINTS-plus feature, obtain neuroimaging for posterior circulation stroke and do not dismiss central localization because early MRI is negative. MRI may miss 20% to 50% of posterior fossa infarctions within 48 hours, and reduced MRI sensitivity during the first 48 hours is specifically recognized for posterior circulation stroke. [1][19]",
        "A central HINTS result remains concerning regardless of early imaging findings. In prospective AVS evaluation, structured HINTS testing was reported to be more sensitive than early MRI diffusion-weighted imaging for posterior circulation stroke detection. [1][3][20][21]",
        "CT is limited for small brainstem infarction, whereas CT perfusion may improve diagnostic accuracy for acute posterior circulation stroke. Imaging should complement, rather than replace, serial neurologic assessment when the bedside phenotype remains central. [2][6]"
      ],
      "bullets": [
        "Central HINTS-plus with negative early MRI: continue stroke concern; reassess clinically and do not use the negative study as a stand-alone exclusion. [1][19]",
        "Normal imaging plus convincing peripheral HINTS pattern: supports peripheral localization only when the examination was performed in the correct AVS population by a trained clinician. [13][14]",
        "CT alone is insufficient reassurance for suspected small brainstem infarction. [2]"
      ],
      "subsections": [],
      "table": {
        "caption": "Imaging limitations in suspected posterior circulation stroke. [1][2][6][19]",
        "columns": [
          "Test or result",
          "Decision-relevant limitation",
          "Clinical response"
        ],
        "rows": [
          [
            "MRI within 48 hours",
            "May miss 20% to 50% of posterior fossa infarctions. [1]",
            "Do not overrule central HINTS-plus findings. [1][19]"
          ],
          [
            "Noncontrast CT",
            "Can be insensitive for small brainstem infarcts. [2]",
            "Do not use a negative CT to dismiss persistent central concern. [2]"
          ],
          [
            "CT perfusion",
            "May improve diagnostic accuracy in acute posterior circulation stroke. [6]",
            "Consider as part of stroke imaging when available and clinically indicated. [6]"
          ]
        ]
      }
    },
    {
      "id": "separate-vestibular-neuritis-from-stroke",
      "eyebrow": "Etiologic Branches",
      "heading": "Distinguish vestibular neuritis from posterior circulation stroke",
      "intro": "Peripheral findings support vestibular neuritis only after central warning signs have been actively excluded.",
      "paragraphs": [
        "Vestibular neuritis is the most common cause of spontaneous AVS and produces objective unilateral peripheral vestibular dysfunction: reduced vestibulo-ocular reflex gain with catch-up saccades on head impulse testing, peripheral unidirectional nystagmus, and no skew deviation. [1][4][20]",
        "Posterior circulation stroke can produce isolated vertigo or dizziness without obvious focal neurologic deficits, particularly when ischemia involves brainstem or cerebellar vestibular structures. This overlap drives frequent frontline misdiagnosis; posterior circulation strokes presenting with dizziness are missed initially in roughly 35% of cases. [13][16]",
        "Do not equate a unilateral abnormal head impulse with vestibular neuritis in every patient. AICA infarction, labyrinthine artery ischemia, and vestibular nucleus infarction can each produce unilateral peripheral vestibular test abnormalities; integrate hearing loss, nystagmus pattern, skew, gait findings, and imaging rather than relying on the head impulse result alone. [1]"
      ],
      "bullets": [
        "Peripheral-compatible AVS: abnormal unilateral head impulse, unidirectional nystagmus, absent skew, and no new unilateral hearing loss. [1][20]",
        "Central-compatible AVS: any central HINTS sign, new unilateral hearing loss, or persistent clinical concern despite early negative MRI. [1][9][19][20]",
        "Isolated dizziness or vertigo does not exclude posterior circulation stroke. [13][16]"
      ],
      "subsections": [],
      "table": {
        "caption": "Decision-focused comparison of vestibular neuritis and posterior circulation stroke in AVS. [1][9][13][20]",
        "columns": [
          "Finding",
          "Vestibular neuritis pattern",
          "Stroke concern",
          "Next action"
        ],
        "rows": [
          [
            "Head impulse",
            "Reduced vestibulo-ocular reflex with corrective saccades. [1][20]",
            "Normal head impulse, or abnormal impulse with new hearing loss. [1][9]",
            "Normal impulse or hearing-loss exception: stroke evaluation. [1][9]"
          ],
          [
            "Nystagmus",
            "Unidirectional pattern. [20]",
            "Direction-changing or gaze-evoked pattern. [9][20]",
            "Treat as central localization. [9]"
          ],
          [
            "Ocular alignment",
            "No skew deviation. [20]",
            "Skew deviation. [20]",
            "Treat as central localization. [20]"
          ],
          [
            "Early MRI",
            "Normal study may support peripheral diagnosis when examination is peripheral. [21]",
            "Negative study does not exclude posterior fossa infarction within 48 hours. [1][19]",
            "Continue stroke pathway if bedside findings are central. [1][19]"
          ]
        ]
      }
    },
    {
      "id": "escalation-and-documentation",
      "eyebrow": "Operational Next Steps",
      "heading": "Escalate central patterns and document why HINTS was interpretable",
      "intro": "The safest documentation links syndrome eligibility, individual eye findings, hearing, and imaging timing.",
      "paragraphs": [
        "Activate a posterior circulation stroke evaluation pathway for AVS with any central HINTS-plus sign, acute unilateral hearing loss, or discordance between a seemingly peripheral examination and the overall neurologic presentation. Posterior circulation stroke can present with subtle findings, and delayed recognition is common when symptoms are mild, nonspecific, or transient. [1][13][16]",
        "Document whether spontaneous nystagmus was present before recording a HINTS result. Record the head impulse result on each side, whether nystagmus remains unidirectional or changes with gaze, the cross-cover test result, bedside hearing result, examiner training, and the time from symptom onset to MRI. This prevents a falsely reassuring label of “negative HINTS” when the test was applied outside AVS or incompletely performed. [11][13][21]",
        "When video head impulse testing is available, reduced vestibulo-ocular reflex gain and refixation saccades provide objective evidence of unilateral peripheral vestibular dysfunction. However, video testing does not independently exclude posterior circulation stroke because select AICA, labyrinthine artery, and vestibular nucleus infarcts can produce the same unilateral abnormality. [1][7]"
      ],
      "bullets": [
        "Escalate: any central HINTS-plus component. [9][20]",
        "Escalate: new unilateral hearing loss in AVS, even with an abnormal head impulse. [1][9]",
        "Escalate: central bedside phenotype despite negative early MRI. [1][19]",
        "Use video head impulse testing as an objective adjunct, not a stand-alone stroke exclusion test. [1][7]"
      ],
      "subsections": [],
      "table": {
        "caption": "Minimum documentation for an AVS evaluation using HINTS-plus. [1][11][13][21]",
        "columns": [
          "Documented item",
          "Why it changes interpretation"
        ],
        "rows": [
          [
            "Continuous AVS symptoms and spontaneous nystagmus",
            "Establishes whether HINTS-plus was applicable. [11][13][21]"
          ],
          [
            "Head impulse, gaze nystagmus, and cross-cover results",
            "Identifies the individual central or peripheral HINTS components. [9][20][21]"
          ],
          [
            "New unilateral hearing loss",
            "Captures the HINTS-plus warning for labyrinthine/AICA ischemia. [1][9]"
          ],
          [
            "MRI timing from symptom onset",
            "Determines the relevance of early false-negative posterior fossa imaging. [1][19]"
          ]
        ]
      }
    }
  ],
  "faq": [],
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  "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.",
  "citations": [
    {
      "number": 1,
      "title": "Video head impulse testing to differentiate vestibular neuritis from posterior circulation stroke in the emergency department: a prospective observational study | BMJ Neurology Open",
      "detail": "neurologyopen.bmj.com",
      "url": "https://neurologyopen.bmj.com/content/4/1/e000284",
      "authors": "neurologyopen.bmj.com",
      "host": "neurologyopen.bmj.com",
      "snippet": "V-HIT measurement of VOR gain, refixation saccade prevalence and amplitude are reliable discriminators of VN from PCS.13 An abnormal v-HIT test defined by the presence of reduced VOR gain and catchup saccades, provides objective evidence of unilateral peripheral vestibular dysfunction. This is most ",
      "score": 0.59344494
    },
    {
      "number": 2,
      "title": "Making a diagnosis in patients who present with vertigo",
      "detail": "www.bmj.com",
      "url": "https://www.bmj.com/content/345/bmj.e5809/rapid-responses",
      "authors": "www.bmj.com",
      "host": "www.bmj.com",
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      "score": 0.72489023
    },
    {
      "number": 3,
      "title": "Quantitative Video-Oculography to Help Diagnose Stroke in Acute Vertigo and Dizziness",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.111.000033",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "Using head impulse test, nystagmus, test-of-skew is more sensitive and less costly than early magnetic resonance imaging for stroke diagnosis in acute vestibular syndrome but requires expertise not routinely available in emergency departments. Vertigo and dizziness account for 2.6 million US emergen",
      "score": 0.74385756
    },
    {
      "number": 4,
      "title": "Diagnosing Stroke in Acute Dizziness and Vertigo",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.117.016979",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "The most common s-AVS cause is vestibular neuritis. Approximately 10% to 20% of patients with s-AVS have stroke (typically in the brain stem or",
      "score": 0.6260562
    },
    {
      "number": 5,
      "title": "HINTS to Diagnose Stroke in the Acute Vestibular Syndrome",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.109.551234",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "Background and Purpose— Acute vestibular syndrome (AVS) is often due to vestibular neuritis but can result from vertebrobasilar strokes.",
      "score": 0.5809471
    },
    {
      "number": 6,
      "title": "Computed Tomography Perfusion Deficit Volumes Predict ...",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.032924",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "Computed tomography perfusion improves diagnostic accuracy in acute posterior circulation stroke. ... German Center for Vertigo and Balance",
      "score": 0.4689128
    },
    {
      "number": 7,
      "title": "Separating posterior-circulation stroke from vestibular neuritis with quantitative vestibular testing",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1388245720303503",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Acute vestibular syndromes (AVS) are characterised by acute vertigo and dizziness associated with nausea/vomiting, motion-intolerance and gait instability, lasting for 24 hours or more (Hotson and Baloh, 1998). Vestibular neuritis (VN) and posterior-circulation stroke (PCS) constitute two common cau",
      "score": 0.76512027
    },
    {
      "number": 8,
      "title": "Posterior circulation stroke diagnosis in unselected group of acutely dizzy patients",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S030384672200422X",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Research article Using “HINTS family” to diagnose stroke in the acute vestibular syndrome: A systematic review and meta-analysis Xu W., …, Yang X.American Journal of Emergency Medicine • Volume 99 • 2026  Show abstract Acute vestibular syndrome (AVS) often arises from benign peripheral causes, yet t",
      "score": 0.7493996
    },
    {
      "number": 9,
      "title": "Using “HINTS family” to diagnose stroke in the acute vestibular syndrome: A systematic review and meta-analysis",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S0735675725006023",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "### Results\n\nWe included 11 studies in the analysis: 11 for HINTS (_n_=1286), 2 for HINTS plus (_n_=265), and 1 for v-HINTS (_n_=50). Their sensitivities for stroke were 0.97 (95%CI: 0.94–0.99), 0.99 (0.95–1.00) and 1.00, with specificities of 0.81 (0.72–0.88), 0.82 (0.74–0.88), and 0.90, respective",
      "score": 0.7101667
    },
    {
      "number": 10,
      "title": "Linking ASC/PSC gain ratio with nystagmus phenotypes in acute ...",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S0196070926000712",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging.",
      "score": 0.68191797
    },
    {
      "number": 11,
      "title": "Acute vertigo: stroke or not? : Current Opinion in Neurology",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/co-neurology/fulltext/2026/02000/acute_vertigo__stroke_or_not_.10.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "In patients with spontaneous nystagmus, it is useful to apply the HINTS bedside assessment. The HINTS exam (Head Impulse, Nystagmus, Test of Skew) is a bedside neurological examination used to differentiate between peripheral and central causes of acute vertigo . HINTS plus adds an assessment of aud",
      "score": 0.62770075
    },
    {
      "number": 12,
      "title": "Acute evaluation of the acute vestibular syndrome: differentiating posterior circulation stroke from acute peripheral vestibulopathies - Tsang - 2017 - Internal Medicine Journal - Wiley Online Library",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.13552",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "This review article aims to provide an evidence-based approach to evaluating the patient who presents with acute prolonged, spontaneous vertigo in the context of the acute vestibular syndrome (AVS). *Stroke* 2009; 40: 3504–10. * 4Abilleira S, Cardona P, Ribo M, Millan M, Obach V, Roquer J *et al.* O",
      "score": 0.82492816
    },
    {
      "number": 13,
      "title": "Bedside Testing in Acute Vestibular Syndrome—Evaluating HINTS Plus and Beyond—A Critical Review",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10514811",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "This emphasizes the need to distinguish between dangerous central and benign, self-limited peripheral vestibular disorders to avoid misdiagnosis. Overall, roughly 9% of cerebrovascular events are missed at the initial ED presentation and risk of misdiagnosis is much greater when the presenting neuro",
      "score": 0.756376
    },
    {
      "number": 14,
      "title": "Posterior circulation stroke diagnosis using HINTS in patients presenting with acute vestibular syndrome: A systematic review",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC6960692",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "23.Venhovens J, Meulstee J, Verhagen W. Acute vestibular syndrome: a critical review and diagnostic algorithm concerning the clinical differentiation of peripheral versus central aetiologies in the emergency department. J Neurol 2016; 263: 2151–2157. [DOI] [PubMed] [Google Scholar]\n   24.Newman-Toke",
      "score": 0.72184175
    },
    {
      "number": 15,
      "title": "Acute and episodic vestibular syndromes caused by ischemic stroke: predilection sites and risk factors",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7218482",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "short-lived vestibular system dysfunction (e.g., nausea, nystagmus, or sudden falls). Anatomically, AVS and/or EVS may occur at any point along the vestibular pathway from the peripheral labyrinth to the central vestibular cortex. Therefore, the causes of vestibular syndrome are divided into two cat",
      "score": 0.70702106
    },
    {
      "number": 16,
      "title": "Progress in the Study of Diagnostic Methods for Central Acute Vestibular Syndrome of a Vascular Cause",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12416380",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "##  is characterized by the sudden onset of dizziness or vertigo, accompanied by nausea, vomiting, gait instability, and nystagmus, lasting for more than 24 hours and often persisting for several days to weeks. Central AVS primarily involves central vestibular structures, such as the brainstem and c",
      "score": 0.70067
    },
    {
      "number": 17,
      "title": "Vestibular Dysfunction - StatPearls - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK558926",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Vestibular dysfunction is a disturbance in the body's balance system due to an insult to the vestibular system of the inner ear, the central nervous system processing centers, or both. The symptoms of peripheral and central vestibular dysfunction may overlap, and a targeted physical examination will",
      "score": 0.588062
    },
    {
      "number": 18,
      "title": "Vertigo in Clinical Practice: Evidence-Based Diagnosis and Treatment",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK482356",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Recent consensus guidelines recommend against routine, unnecessary radiographic imaging for patients who meet the diagnostic criteria for BPPV, unless additional signs or symptoms suggest otherwise. No additional vestibular testing is required for patients diagnosed with BPPV who do not exhibit othe",
      "score": 0.44999737
    },
    {
      "number": 19,
      "title": "Central Vertigo - StatPearls - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK441861",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "## History and Physical\n\nThe most important clinical scenario is when a patient presents to the emergency department or urgent care with acute vertigo. Most patients with vertigo have a peripheral cause, including benign paroxysmal positional vertigo, acute vestibular neuritis (or labyrinthitis), Me",
      "score": 0.43295085
    },
    {
      "number": 20,
      "title": "Hints to the H.I.N.T.S. Exam for Acute Vestibular Syndrome | Neurology Education",
      "detail": "www.neurology.org",
      "url": "https://www.neurology.org/doi/full/10.1212/NE9.0000000000200248",
      "authors": "www.neurology.org",
      "host": "www.neurology.org",
      "snippet": "# Hints to the H.I.N.T.S. Exam for Acute Vestibular Syndrome. Sudden-onset, constant vertigo with nausea/vomiting, gait unsteadiness, and spontaneous nystagmus define acute vestibular syndrome (AVS). This Figure details the Head-Impulse-Nystagmus-Test-of-Skew (HINTS) exam, which uses special maneuve",
      "score": 0.81524754
    },
    {
      "number": 21,
      "title": "HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging - PubMed",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/pubmed/19762709",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Title: HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging - PubMed\nAn official website of the United States government. **The .gov means it’s official.**. Federal government websites often end ",
      "score": 0.78194773
    },
    {
      "number": 22,
      "title": "Can Bedside Oculomotor (HINTS) Testing Differentiate Central From Peripheral Causes of Vertigo? - Annals of Emergency Medicine",
      "detail": "www.annemergmed.com",
      "url": "https://www.annemergmed.com/article/S0196-0644(14)00022-5/abstract",
      "authors": "www.annemergmed.com",
      "host": "www.annemergmed.com",
      "snippet": "Title: Can Bedside Oculomotor (HINTS) Testing Differentiate Central From Peripheral Causes of Vertigo? - Annals of Emergency Medicine\nArticle access provided by ACEP in this session. Neurology/best available evidenceVolume 64, Issue 3X0021-6)p265-268September 2014. # Can Bedside Oculomotor (HINTS) T",
      "score": 0.7393665
    },
    {
      "number": 23,
      "title": "Kopfimpuls, Nystagmus und Skew‐Test zur Diagnose zentraler ...",
      "detail": "www.cochranelibrary.com",
      "url": "https://www.cochranelibrary.com/es/cdsr/doi/10.1002/14651858.CD015089.pub2/references/de",
      "authors": "www.cochranelibrary.com",
      "host": "www.cochranelibrary.com",
      "snippet": "Posterior circulation stroke diagnosis using HINTS in patients presenting with acute vestibular syndrome: a systematic review. European Stroke Journal 2019",
      "score": 0.6994397
    },
    {
      "number": 24,
      "title": "Hints to the H.I.N.T.S. Exam for Acute Vestibular Syndrome",
      "detail": "www.neurology.org",
      "url": "https://www.neurology.org/doi/10.1212/NE9.0000000000200248",
      "authors": "www.neurology.org",
      "host": "www.neurology.org",
      "snippet": "Go to FigureOpen in Viewer\n\n## Tables\n\n## Media\n\n## Share\n\n### Share\n\n#### Share article link\n\nCopy Link\n\nCopied!\n\nCopying failed.\n\n#### Share\n\nFacebookX (formerly Twitter)\")LinkedInemail\n\n## References\n\n### References\n\n#### References\n\n1.\n\nKattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. H",
      "score": 0.69498676
    }
  ],
  "publishedAt": "2026-09-15T21:22:30.426364+00:00",
  "updatedAt": "2026-09-15T21:22:30.426364+00:00",
  "readingMinutes": 6,
  "slug": "acute-vertigo-evaluation"
}