A Guide to Patients with Acute Transient Vestibular Symptoms in the Emergency Department.
Early MRI can miss brainstem strokes causing transient dizziness in up to 20% of cases
A Guide to Patients with Acute Transient Vestibular Symptoms in the Emergency Department.
As many as two-thirds of acutely dizzy patients presenting to the emergency department report intermittent symptoms only, consistent with a transient acute vestibular syndrome (single episode lasting < 24 h) or an episodic vestibular syndrome (recurrent episodes, each lasting < 24 h).
This critical review provides an overview on the management of transient vestibular symptoms, focusing on structured history-taking and bedside testing, but also reviewing the role of neuroimaging and eye movement recordings.
Early MRI scans falsely appear normal in up to 20% of true strokes causing dizziness.
Asking about timing and triggers helps clarify the temporal evolution of symptoms (transient vs. persistent) and the circumstances of occurrence (spontaneous vs. triggered).
Such structured history-taking narrows down the differential diagnosis and ensures appropriate bedside tests.
On clinical examination, identifying focal neurologic signs, (subtle) ocular motor findings, and gait imbalance is essential.
Quantitative eye movement recordings may be especially valuable in rural areas, supporting telemedicine consults.
Special emphasis should be put on distinguishing vertebrobasilar transient ischemic attack from vestibular migraine and cardiac arrhythmia.
In the case of triggered transient vestibular symptoms, immediate and sustained response to liberation maneuvers strongly supports benign paroxysmal positional vertigo over vestibular migraine or structural central positional nystagmus.
Treatment strategies in transient vestibular symptoms strongly depend on the underlying cause, ranging from hyperacute stroke treatment to migraine prophylaxis to liberation maneuvers.