Journal of Neurology

, Volume 263, Issue 11, pp 2151–2157 | Cite as

Acute vestibular syndrome: a critical review and diagnostic algorithm concerning the clinical differentiation of peripheral versus central aetiologies in the emergency department

  • J. VenhovensEmail author
  • J. Meulstee
  • W. I. M. Verhagen


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.


Acute vestibular syndrome (AVS) HINTS Head impulse test (HIT) Vertigo Vertebrobasilar stroke 


Compliance with ethical standards

Conflicts of interest

None to be disclosed.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • J. Venhovens
    • 1
    Email author
  • J. Meulstee
    • 2
  • W. I. M. Verhagen
    • 2
  1. 1.Department of Neurology and Clinical NeurophysiologyAlbert Schweitzer HospitalDordrechtThe Netherlands
  2. 2.Department of Neurology and Clinical NeurophysiologyCanisius Wilhelmina HospitalNijmegenThe Netherlands

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