A review of the diagnostic approaches in patients with acute vertigo, dizziness and imbalance

Abstract

　We have reviewed previously reported procedures for diagnosing vertigo, dizziness and imbalance. Most experts recommend first distinguishing between pre-syncope and other symptoms. The symptoms are then classified into 4 or 5 categories according to the clinical history (acute or chronic, triggered or spontaneous, continuous or episodic). Further differential diagnosis is then needed in each category. A recent trend in the classification is not to focus on rotational vertigo or non-rotational dizziness as a symptom.

　The most important consideration in diagnosing the cause of acute vertigo is stroke detection, which is often difficult to distinguish from peripheral vestibular disorders. There are three possible strategies: (1) use of an algorithm, such as a flowchart, (2) defining symptoms/findings suggestive of a stroke, and (3) scoring and evaluation of the symptoms/findings. The sensitivity and specificity are increased by defining multiple symptoms and findings suggestive of stroke. However, if many specialized findings are required, it lacks versatility as a diagnostic procedure. The optimal strategy differs depending on the situation, the target patient, and the doctor. The strategies are expected to continue to be evaluated and improved.