Acute Vestibular Syndrome

Kevin A. Kerber

doi:10.1055/s-0039-3402739

Seminars in Neurology, Table of Contents

Semin Neurol 2020; 40(01): 059-066
DOI: 10.1055/s-0039-3402739

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Acute Vestibular Syndrome

Kevin A. Kerber

¹Department of Neurology, Health Services Research Program, University of Michigan, Ann Arbor, Michigan

› Author Affiliations

Abstract

The acute vestibular syndrome (AVS) is a label for presentations of new-onset severe dizziness, vertigo, or imbalance, with examination findings of nystagmus or gait unsteadiness. The prototypical AVS presentation is the acute unilateral vestibulopathy due to vestibular neuritis. Stroke is also a serious concern in patients with AVS. Most other peripheral vestibular disorders present as episodic or chronic syndromes. In this article, the diagnostic considerations, exam findings, and management of AVS are reviewed.

Keywords

vertigo - acute vestibular syndrome - vestibulopathy - stroke

Full Text

References

References
1 Kerber KA, Meurer WJ, West BT, Fendrick AM. Dizziness presentations in U.S. emergency departments, 1995-2004. Acad Emerg Med 2008; 15 (08) 744-750
2 Kerber KA, Brown DL, Lisabeth LD, Smith MA, Morgenstern LB. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 2006; 37 (10) 2484-2487
3 Kerber KA, Meurer WJ, Brown DL. , et al. Stroke risk stratification in acute dizziness presentations: a prospective imaging-based study. Neurology 2015; 85 (21) 1869-1878
4 Kerber KA, Callaghan BC, Telian SA. , et al. Dizziness symptom type prevalence and overlap: a US nationally representative survey. Am J Med 2017; 130 (12) 1465.e1-1465.e9
5 Newman-Toker DE, Cannon LM, Stofferahn ME, Rothman RE, Hsieh YH, Zee DS. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc 2007; 82 (11) 1329-1340
6 Eagles D, Stiell IG, Clement CM. , et al. International survey of emergency physicians' priorities for clinical decision rules. Acad Emerg Med 2008; 15 (02) 177-182
7 Kleindorfer DO, Miller R, Moomaw CJ. , et al. Designing a message for public education regarding stroke: does FAST capture enough stroke?. Stroke 2007; 38 (10) 2864-2868
8 Kim AS, Fullerton HJ, Johnston SC. Risk of vascular events in emergency department patients discharged home with diagnosis of dizziness or vertigo. Ann Emerg Med 2011; 57 (01) 34-41
9 Kerber KA, Zahuranec DB, Brown DL. , et al. Stroke risk after nonstroke emergency department dizziness presentations: a population-based cohort study. Ann Neurol 2014; 75 (06) 899-907
10 Grewal K, Austin PC, Kapral MK, Lu H, Atzema CL. Missed strokes using computed tomography imaging in patients with vertigo: population-based cohort study. Stroke 2015; 46 (01) 108-113
11 Atzema CL, Grewal K, Lu H, Kapral MK, Kulkarni G, Austin PC. Outcomes among patients discharged from the emergency department with a diagnosis of peripheral vertigo. Ann Neurol 2016; 79 (01) 32-41
12 Goudakos JK, Markou KD, Psillas G, Vital V, Tsaligopoulos M. Corticosteroids and vestibular exercises in vestibular neuritis. Single-blind randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2014; 140 (05) 434-440
13 Ismail EI, Morgan AE, Rahman AM. Corticosteroids versus vestibular rehabilitation in long-term outcomes in vestibular neuritis. J Vestib Res 2018; 28 (5-6): 417-424
14 Taylor RL, McGarvie LA, Reid N, Young AS, Halmagyi GM, Welgampola MS. Vestibular neuritis affects both superior and inferior vestibular nerves. Neurology 2016; 87 (16) 1704-1712
15 Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 2011; 183 (09) E571-E592
16 Lin HC, Chao PZ, Lee HC. Sudden sensorineural hearing loss increases the risk of stroke: a 5-year follow-up study. Stroke 2008; 39 (10) 2744-2748
17 Chang TP, Wang Z, Winnick AA. , et al. Sudden hearing loss with vertigo portends greater stroke risk than sudden hearing loss or vertigo alone. J Stroke Cerebrovasc Dis 2018; 27 (02) 472-478
18 Rujescu D, Hartmann AM, Giegling I. , et al. Genome-wide association study in vestibular neuritis: involvement of the host factor for HSV-1 replication. Front Neurol 2018; 9: 591
19 MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS. The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology 2009; 73 (14) 1134-1141
20 Newman-Toker DE, Saber Tehrani AS, Mantokoudis G. , et al. Quantitative video-oculography to help diagnose stroke in acute vertigo and dizziness: toward an ECG for the eyes. Stroke 2013; 44 (04) 1158-1161
21 Newman-Toker DE, Kerber KA, Hsieh YH. , et al. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med 2013; 20 (10) 986-996
22 Cohen JI. Herpes zoster. N Engl J Med 2013; 369 (18) 1766-1767
23 Kerber KA, Burke JF, Brown DL. , et al. Does intracerebral haemorrhage mimic benign dizziness presentations? A population based study. Emerg Med J 2012; 29 (01) 43-46
24 Kerber KA, Forman J, Damschroder L. , et al. Barriers and facilitators to ED physician use of the test and treatment for BPPV. Neurol Clin Pract 2017; 7 (03) 214-224
25 Newman-Toker DE, Stanton VA, Hsieh YH, Rothman RE. Frontline providers harbor misconceptions about the bedside evaluation of dizzy patients. Acta Otolaryngol 2008; 128 (05) 601-604
26 Kerber KA, Morgenstern LB, Meurer WJ. , et al. Nystagmus assessments documented by emergency physicians in acute dizziness presentations: a target for decision support?. Acad Emerg Med 2011; 18 (06) 619-626
27 Weber KP, Aw ST, Todd MJ, McGarvie LA, Curthoys IS, Halmagyi GM. Head impulse test in unilateral vestibular loss: vestibulo-ocular reflex and catch-up saccades. Neurology 2008; 70 (06) 454-463
28 Kim TS, Lim HW, Yang CJ. , et al. Changes of video head impulse test results in lateral semicircular canal plane by different peak head velocities in patients with vestibular neuritis. Acta Otolaryngol 2018; 138 (09) 785-789
29 Choi JY, Kim HJ, Kim JS. Recent advances in head impulse test findings in central vestibular disorders. Neurology 2018; 90 (13) 602-612
30 Lee H. Audiovestibular loss in anterior inferior cerebellar artery territory infarction: a window to early detection?. J Neurol Sci 2012; 313 (1-2): 153-159
31 Lee H, Kim JS, Chung EJ. , et al. Infarction in the territory of anterior inferior cerebellar artery: spectrum of audiovestibular loss. Stroke 2009; 40 (12) 3745-3751
32 Johnston SC, Rothwell PM, Nguyen-Huynh MN. , et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007; 369 (9558): 283-292
33 Navi BB, Kamel H, Shah MP. , et al. Application of the ABCD2 score to identify cerebrovascular causes of dizziness in the emergency department. Stroke 2012; 43 (06) 1484-1489
34 Choi KD, Oh SY, Kim HJ, Kim JS. The vestibulo-ocular reflexes during head impulse in Wernicke's encephalopathy. J Neurol Neurosurg Psychiatry 2007; 78 (10) 1161-1162
35 von Brevern M, Bertholon P, Brandt T. , et al. Benign paroxysmal positional vertigo: Diagnostic criteria. J Vestib Res 2015; 25 (3-4): 105-117
36 Brazzelli M, Sandercock PA, Chappell FM. , et al. Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms. Cochrane Database Syst Rev 2009; (04) CD007424
37 Chalela JA, Kidwell CS, Nentwich LM. , et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 2007; 369 (9558): 293-298
38 Oppenheim C, Stanescu R, Dormont D. , et al. False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol 2000; 21 (08) 1434-1440
39 Saber Tehrani AS, Kattah JC, Mantokoudis G. , et al. Small strokes causing severe vertigo: frequency of false-negative MRIs and nonlacunar mechanisms. Neurology 2014; 83 (02) 169-173
40 Axer H, Grässel D, Brämer D. , et al. Time course of diffusion imaging in acute brainstem infarcts. J Magn Reson Imaging 2007; 26 (04) 905-912
41 Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40 (11) 3504-3510
42 Carmona S, Martínez C, Zalazar G. , et al. the diagnostic accuracy of truncal ataxia and HINTS as cardinal signs for acute vestibular syndrome. Front Neurol 2016; 7: 125
43 Rothwell PM, Algra A, Chen Z, Diener HC, Norrving B, Mehta Z. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials. Lancet 2016; 388 (10042): 365-375
44 Shupak A, Issa A, Golz A, , Margalit Kaminer, Braverman I. Prednisone treatment for vestibular neuritis. Otol Neurotol 2008; 29 (03) 368-374
45 McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev 2015; 1: CD005397
46 Hall CD, Herdman SJ, Whitney SL. , et al. Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence-based clinical practice guideline: from the American Physical Therapy Association Neurology Section. J Neurol Phys Ther 2016; 40 (02) 124-155
47 Teggi R, Caldirola D, Fabiano B, Recanati P, Bussi M. Rehabilitation after acute vestibular disorders. J Laryngol Otol 2009; 123 (04) 397-402
48 Venosa AR, Bittar RS. Vestibular rehabilitation exercises in acute vertigo. Laryngoscope 2007; 117 (08) 1482-1487
49 Fishman JM, Burgess C, Waddell A. Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Database Syst Rev 2011; (05) CD008607
50 Strupp M, Zingler VC, Arbusow V. , et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med 2004; 351 (04) 354-361
51 Yip CW, Strupp M. The Dizziness Handicap Inventory does not correlate with vestibular function tests: a prospective study. J Neurol 2018; 265 (05) 1210-1218
52 Mutlu B, Serbetcioglu B. Discussion of the dizziness handicap inventory. J Vestib Res 2013; 23 (06) 271-277
53 Waljee AK, Rogers MA, Lin P. , et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ 2017; 357: j1415
54 Marill KA, Walsh MJ, Nelson BK. Intravenous lorazepam versus dimenhydrinate for treatment of vertigo in the emergency department: a randomized clinical trial. Ann Emerg Med 2000; 36 (04) 310-319
55 Irving C, Richman P, Kaiafas C, Eskin B, Allegra J. Intramuscular droperidol versus intramuscular dimenhydrinate for the treatment of acute peripheral vertigo in the emergency department: a randomized clinical trial. Acad Emerg Med 2002; 9 (06) 650-653
56 Amini A, Heidari K, Asadollahi S. , et al. Intravenous promethazine versus lorazepam for the treatment of peripheral vertigo in the emergency department: a double blind, randomized clinical trial of efficacy and safety. J Vestib Res 2014; 24 (01) 39-47
57 Shafipour L, Hkhatir IG, Shafipour V, Ahidashti HA, Charati JY. Intravenous promethazone versus diazepam for treatment of peripheral vertigo in emergency department. Majallah-i Danishgah-i Ulum-i Pizishki-i Mazandaran 2017; 27 (149) 88-98
58 Saberi A, Pourshafie SH, Kazemnejad-Leili E, Nemati S, Sutohian S, Sayad-Fathi S. Ondansetron or promethazine: which one is better for the treatment of acute peripheral vertigo?. Am J Otolaryngol 2019; 40 (01) 10-15
59 Doğan NÖ, Avcu N, Yaka E, Yılmaz S, Pekdemir M. Comparison of the therapeutic efficacy of intravenous dimenhydrinate and intravenous piracetam in patients with vertigo: a randomised clinical trial. Emerg Med J 2015; 32 (07) 520-524