UNASSIGNED: Managing acute vertigo/dizziness for inpatients requires valid communication between the various healthcare professionals that triage such life-threatening presentations, yet there are no current scaling methods for managing such acute vertigo symptoms for inpatients.
UNASSIGNED: To describe the development and validation of the Krems Acute Vertigo/Dizziness Scale (KAVEDIS), a new instrument for tracking subjective symptoms (vertigo, dizziness) and gait impairment across four unique vestibular diagnoses (Menière\'s disease, benign paroxysmal positional vertigo, peripheral vestibular hypofunction, and vestibular migraine) over a one-year period after inpatient hospital admission.
UNASSIGNED: Retrospective data collection study from KAVEDIS scale and chart documentation.
UNASSIGNED: The KAVEDIS scale can significantly distinguish scores from admission to discharge in three of four vestibular diagnoses. The documented course of subjective vestibular symptoms and gait disturbances were correlated in all four groups.
UNASSIGNED: We suggest that KAVEDIS documentation among inpatients admitted with acute vertigo/dizziness may improve communication between the various intervening clinicians and help to raise concern in cases of symptomprogression.

Background: Patients with undifferentiated acute dizziness usually report with rapid onset of severe, often disabling illusion of movement with many other features. This accounts for roughly 50 to 100 million visits globally in emergencies annually. The causes may be numerous. Thus, the perplexed clinician needs to pursue advanced diagnostic imaging and unnecessary hospital admission in these patients. Aims and objectives: This study aims to assess the validity of HINTS Plus (head impulse test-nystagmus-test of skew + hearing assessment) test in diagnosing central causes of vertigo in patients with acute undifferentiated vertigo presenting within 72 h of onset of symptoms. The other objectives are to understand epidemiology and describe the assessment and management of these patients. Method: The data of 82 patients who visited the clinic within 72 h of the onset of symptoms as mentioned earlier during two years from August 2021 to 2023 at Ankush Hospital was stratified and analyzed. The outcome is reported here. Results: Among 82 patients, peripheral vestibular cause accounts for 84%. 12% were due to ischemic stroke and cardiovascular reasons. The sensitivity of HINTS Plus in isolating central acute vestibular vertigo was 100%, and the specificity was 95.6%. Conclusion: The risk for central and cerebrovascular causes of dizziness increases in the elderly with the presence of neurological signs and other comorbidities. The sensitivity and specificity of HINTS plus (4 Components) is very high in identifying central causes of undifferentiated acute vestibular in the first 72 h of onset of symptoms when undertaken by a trained clinician.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s12070-024-04493-2.

UNASSIGNED: To assess the efficacy and safety of prochlorperazine in Indian patients with acute vertigo.
UNASSIGNED: In this prospective, multicenter, open-label, post-marketing observational study, patients with acute peripheral vertigo of different etiologies received 5 mg prochlorperazine thrice a day for 5 days. The primary endpoints were percentage of patients with improvement in (1) vertigo symptoms and (2) clinical response as per scale for vestibular vertigo severity level and clinical response evaluation (SVVSLCRE) from baseline to end of treatment (Day 6). The key secondary endpoints were (1) improvement in nystagmus grading, and (2) safety and tolerability Efficacy of prochlorperazine by route of administration of first prochlorperazine dose (oral or intramuscular) was also assessed.
UNASSIGNED: Of 1716 enrolled patients (mean [standard deviation, SD]) age (42.0 [12.95] years; 53.6% men), 57.4% were diagnosed with Meniere\'s disease, followed by vestibular neuritis (17.4%), labyrinthitis (16.7%), or ear surgery (8.5%). In the overall population, 91.1% of patients showed improvement in clinical response per SVVSLCRE grading at Day 6 (p < 0.0001 vs. non-responders). Nystagmus grading was improved in 99.7% (of patients. No adverse drug reactions events were reported. Tolerability of prochlorperazine was rated as good, very good, and excellent by 43.6%, 32.9% and 20.7% of patients, respectively. Among patients with postoperative vertigo, 80.1% showed improvement in clinical response. In the intramuscular and oral subsets, 85.5% and 92.1% of patients showed improved clinical response, respectively.
UNASSIGNED: Prochlorperazine showed improvement in severity of symptoms and clinical response in all subsets of vertigo patients, with a good safety and tolerability profile.
UNASSIGNED: CTRI/2022/01/039287.
UNASSIGNED: 10 January 2022.

(1) Background: Usually, the majority of patients suffering from vertigo and dizziness can be identified in four major categories: acute spontaneous vertigo, episodic (recurrent) vertigo, recurrent positional vertigo, and chronic imbalance. Our purpose is to retrospectively evaluate the main causes of episodic vertigo and to find indications for a reliable clinical suspicion useful for a definitive diagnosis, comparing patients affected by different presenting symptomatology (acute vertigo, recurrent episodic vertigo, and imbalance). (2) Methods: we retrospectively evaluated the clinical records in a population of 249 consecutive patients observed for vertigo in our tertiary referral center in the period 1 January 2019-31 January 2020. On the basis of the reported clinical history, patients were divided into three groups: patients with their first ever attack of vertigo, patients with recurrent vertigo and dizziness, and patients with chronic imbalance. (3) Results: On the basis of the results of the instrumental examination, we arbitrarily divided (for each type of symptoms) the patients in a group with a normal vestibular instrumental examination and a group of patients in which the clinical-instrumental evaluation showed some pathological results; a highly significant difference (p: 0.157) was found between recurrent and acute vertigo and between recurrent vertigo and imbalance. (4) Conclusions: Patients with recurrent vertigo more frequently exhibit a negative otoneurological examination since they are often examined in the intercritical phase. A precise and in-depth research of the patient\'s clinical history is the key to suspect or make a diagnosis together with the search for some instrumental or clinical hallmark, especially in cases where the clinical picture does not fully meet the international diagnostic criteria.

UNASSIGNED: Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. However, positional vertigo can also be due to diseases affecting the central vestibular pathways, such as vestibular migraine. Accurate and timely diagnosis enables effective triage and management.
UNASSIGNED: To evaluate diagnoses made by emergency clinicians compared to acute vertigo specialists, in patients presenting to an emergency department (ED) with positional vertigo.
UNASSIGNED: Following routine ED care, patients with a primary complaint of dizziness, vertigo, light-headedness or unsteadiness, underwent detailed neuro-otological assessment by acute vertigo specialists. Demographics and final diagnoses were recorded and analyzed.
UNASSIGNED: Of 71 consented patients (21-91 years; mean 56 years, ±16.7 years, 40 females), ED identified 13 with a peripheral cause of positional vertigo (mean 48.85 years, ±16.19, 8 females). Central positional nystagmus was not noted in any of the patients with positional vertigo seen by the ED clinicians. Acute vertigo specialists diagnosed nine patients with BPPV (age range 50-88 years, mean 66 years, ±12.22, 5 females), and six with central positional nystagmus (age range 23-59 years, mean 41.67 years, ±15.78, 6 females).
UNASSIGNED: Positional vertigo should be assessed with positional maneuvers such as Dix-Hallpike and Roll tests in the ED to identify peripheral and central nystagmus features. Central causes are more common in younger females, with the presence of vomiting, and/or a background of motion sensitivity.

UNASSIGNED: The bithermal caloric test is commonly used to detect a canal paresis. However, in case of spontaneous nystagmus, this procedure can provide results of non-univocal interpretation. On the other hand, confirming the presence of a unilateral vestibular deficit can help to differentiate between central and a peripheral vestibular involvement.
UNASSIGNED: We studied 78 patients suffering from acute vertigo and showing spontaneous horizontal unidirectional nystagmus. All patients were submitted to bithermal caloric tests, and the results were compared with those obtained using a monothermal (cold) caloric test.
UNASSIGNED: We demonstrate the congruence between the bithermal and monothermal (cold) caloric test through mathematical analysis of the results of both tests in patients with acute vertigo and spontaneous nystagmus.
UNASSIGNED: We propose to perform the caloric test in the presence of a spontaneous nystagmus using a monothermal cold assuming that the prevalence of the response to the cold irrigation on the side towards which the nystagmus beats is a sign of the presence of pathological unilateral weakness and therefore more likely peripheral in its origin.
Il ruolo del test monotermico freddo in presenza di nistagmo spontaneo.
UNASSIGNED: Il test calorico bitermico è comunemente usato per rilevare una riduzione dell’attività di un singolo labirinto. Tuttavia, in caso di nistagmo spontaneo, questa procedura potrebbe fornire risultati di non univoca interpretazione. D’altra parte, la conferma della presenza di un deficit vestibolare unilaterale potrebbe aiutare a differenziare tra un coinvolgimento vestibolare centrale e uno periferico.
UNASSIGNED: Abbiamo studiato 78 pazienti affetti da vertigine acuta e che mostravano un nistagmo spontaneo orizzontale unidirezionale. Tutti i pazienti sono stati sottoposti al test calorico bitermico, i cui risultati sono stati confrontati con quelli ottenuti attraverso un test calorico monotermico freddo (ice water test).
UNASSIGNED: Attraverso un’analisi matematica dei risultati di entrambi i test in una serie consecutiva di pazienti con vertigine acuta e nistagmo spontaneo, la congruenza tra il test calorico bitermico e quello monotermico freddo può essere dimostrata.
UNASSIGNED: Si propone di eseguire il test calorico in presenza di un nistagmo spontaneo, utilizzando uno stimolo monotermico freddo, considerando che la prevalenza della risposta alla prova fredda sul lato verso cui batte il nistagmo sia indicativo della presenza di deficit labirintico monolaterale.

Objective: The aim of this study was to present some cases of acute vertigo potentially related to the coronavirus disease 2019 (COVID-19) vaccine and review the available literature about cochleovestibular dysfunction after the COVID-19 vaccination. Methods: In the period from May to July 2021, we evaluated 33 patients (mean age 54.3 ± 14.1) with \"acute vertigo\" post COVID-19 vaccination. A detailed medical history was taken on comorbidities, types of vaccines received, and symptoms associated. All patients underwent otoneurological evaluation, such as head impulse test, nystagmus evaluation, test of skew (HINTS) examination. Head shaking test-induced nystagmus, hyperventilation-induced nystagmus, and parossistic positional nystagmus were studied to search for vestibular impairment. Results: Symptoms included 16 patients (48.5%) with objective vertigo, 14 patients (42.4%) with subjective vertigo, and 3 patients (9.1%) with dizziness. Of the associated ear, nose, and throat (ENT) symptoms, the most expressed was tinnitus (18.2%). Bedside examination showed absent nystagmus in 7 patients (21.2%), 9 patients (27.3%) had horizontal or rotatory nystagmus, 17 patients (51.5%) had a vertical or oblique nystagmus, negative HST, or \"central HINTS.\" Discussion and Conclusions: The 9 patients had an evoked nystagmus pathognomonic for benign paroxysmal positional vertigo; in the remaining 17 cases, peripheral vestibular dysfunction could be excluded and central disorder may be suggested. Due to the prevalence of nystagmus of non-peripheral origin, a central nervous system involvement could not be excluded. However, due to the small sample size, a definite cause-effect relationship between vaccination and vertigo cannot be inferred. In light of expected third dose, large-scale and well-designed studies are needed to better define possible adverse reactions of the COVID-19 vaccine.

Meccanismi vascolari nella vestibolopatia periferica acuta unilaterale: una revisione sistematica.
UNASSIGNED: La vestibolopatia periferica unilaterale acuta (AUPVP) è causa frequente di perdita della funzione vestibolare. Sono state proposte diverse eziologie, ma il meccanismo esatto rimane sconosciuto. Lo scopo di questo studio è condurre un’analisi sistematica della letteratura per valutare l’eziologia vascolare dell’AUPVP. Una ricerca sistematica della letteratura è stata eseguita mediante PubMed, Cochrane Library ed Embase, includendo articoli pubblicati dal 1 gennaio 2010 al 30 novembre 2020. Due revisori hanno selezionato in modo indipendente articoli che studiano un collegamento tra AUPVP e malattie vascolari. Sono state estratte le seguenti informazioni: anno di pubblicazione, paese, livello di evidenza, fattori di rischio vascolare valutati e numero di pazienti. In totale sono stati identificati 450 articoli. Tra questi sono stati considerati gli undici su cui vi era completo accordo fra i due revisori. In una popolazione aggregata di 805 pazienti, i risultati principali sono stati il più alto rapporto tra neutrofili e linfociti e la maggiore prevalenza di fattori di rischio vascolare tra i pazienti con AUPVP. Non è stata eseguita una meta-analisi perché gli studi erano troppo eterogenei per quanto riguarda la metodologia. Sono stati trovati argomenti indiretti per i meccanismi vascolari in AUPVP. Questi risultati indicano che sono necessari studi prospettici più ampi e ben controllati per chiarire l’eziologia vascolare in AUPVP.
Acute unilateral peripheral vestibulopathy (AUPVP) is a frequent cause of vestibular loss. Several aetiologies have been proposed, but the exact mechanism remains unknown. The aim of this study is a systematic analysis of the literature evaluating the vascular aetiology of AUPVP. A systematic literature search was performed in PubMed, Cochrane Library and Embase, including articles published from January 1st, 2010 to November 30th, 2020. Two reviewers independently selected articles investigating a link between AUPVP and vascular disease. The following information was extracted: year of publication, country, level of evidence, assessed vascular risk factors and number of patients. A total of 450 articles was obtained. Eleven articles were retained with 100% agreement between the two reviewers. In a pooled population of 805 patients, the main results were the higher neutrophil to lymphocyte ratio and higher prevalence of vascular risk factors among AUPVP patients. A meta-analysis was not performed because the studies were too heterogeneous in terms of methodology. Indirect arguments for vascular mechanisms in AUPVP were found. These findings indicate that larger prospective well-controlled studies are needed to clarify the vascular aetiology of AUPVP.

In posterior circulation stroke, vertigo can be a presenting feature. However, whether isolated hemispheric strokes present with vertigo is less clear, despite a few single case reports in the literature. Here, (a) the prevalence of vertigo/dizziness in acute stroke is explored and (b) the cortical distribution of the lesions in relation to both the known vestibular cortex and the evolution of the symptoms, are considered.
Structured interviews were conducted in 173 consecutive unselected patients admitted to the hyperacute stroke unit at the University College London Hospitals. The interview was used to evaluate whether the patient was suffering from dizziness and/or vertigo before the onset of the stroke and at the time of the stroke (acute dizziness/vertigo), and the nature of these symptoms.
In all, 53 patients had cortical infarcts, of which 21 patients reported acute dizziness. Out of these 21, five patients reported rotational vertigo. Seventeen of the total 53 patients had lesions in known vestibular cortical areas distributed within the insular and parietal opercular cortices.
The prevalence of vertigo in acute cortical strokes was 9%, with no single locus of lesion overlap. There is growing evidence supporting a lateralized vestibular cortex, with speculation that cortical strokes affecting the right hemisphere are more likely to cause vestibular symptoms than left hemispheric strokes. A trend was observed for this association, with the right hemisphere affected in four of five patients who reported spinning vertigo at the onset of the stroke.

BACKGROUND: Acute vertigo is a common presentation of inner ear disease. However, it can also be caused by more serious conditions, especially posterior circulation stroke. Differentiating between these two conditions by clinical presentations and imaging studies during the acute phase can be challenging. This study aimed to identify serum microRNA (miRNA) candidates that could differentiate between posterior circulation stroke and peripheral vertigo, among patients presenting with acute vertigo.
METHODS: Serum levels of six miRNAs including miR-125a-5p, miR-125b-5p, miR-143-3p, miR-342-3p, miR-376a-3p, and miR-433-5p were evaluated. Using quantitative reverse-transcription polymerase chain reaction (RT-qPCR), the serum miRNAs were assessed in the acute phase and at a 90 day follow-up visit.
RESULTS: A total of 58 patients with posterior circulation stroke (n = 23) and peripheral vertigo (n = 35) were included in the study. Serum miR-125a-5p (P = 0.001), miR-125b-5p (P <  0.001), miR-143-3p (P = 0.014) and miR-433-5p (P = 0.0056) were present at significantly higher levels in the acute phase, in the patients with posterior circulation infarction. Based on the area under the receiver operating characteristic curve (AUROC) only miR-125a-5p (0.75), miR-125b-5p(0.77), and miR-433-5p (0.71) had an acceptable discriminative ability to differentiate between the central and peripheral vertigo. A combination of miRNAs revealed no significant improvement of AUROC when compared to single miRNAs.
CONCLUSIONS: This study demonstrated the potential of serum miR-125a-5p, miR-125b-5p, and miR-433-5p as biomarkers to assist in the diagnosis of posterior circulation infarction among patients presenting with acute vertigo.