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Review
. 2025 Mar;109(2):373-388.
doi: 10.1016/j.mcna.2024.09.006. Epub 2024 Dec 31.

Evaluation of Acute Dizziness and Vertigo

Anand K Bery  1 , David E Hale  2 , David E Newman-Toker  3 , Ali S Saber Tehrani  4
Affiliations
Review

Evaluation of Acute Dizziness and Vertigo

Anand K Bery et al. Med Clin North Am. 2025 Mar.

Abstract

Dizziness and vertigo are common presenting symptoms in acute care settings. This article describes the most common causes of acute dizziness and vertigo with practical, evidence-based guidance on evaluation of these patients. A timing-and-triggers approach should be used to first characterize the patient's vestibular symptoms as continuous or episodic. If acute and continuous, determine whether symptoms are post-exposure or spontaneous. If episodic, determine whether symptoms are triggered or spontaneous. Classify the patient as having post-exposure acute vestibular syndrome (AVS), spontaneous AVS, triggered episodic vestibular syndrome (EVS), or spontaneous EVS.

Keywords: Benign paroxysmal positional vertigo; Dizziness; Ischemic stroke; Nystagmus; Vertigo; Vestibular migraine; Vestibular neuritis.

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Conflict of interest statement

Disclosure Dr D.E. Newman-Toker reports grants and contracts related to dizziness/stroke diagnosis and diagnostic error from the Agency for Healthcare Research and Quality, United States, Gordon and Betty Moore Foundation, United States, Society to Improve Diagnosis in Medicine, United States, and Natus Inc.; medicolegal consulting for both plaintiff and defense firms related to misdiagnosis of neurologic conditions, including dizziness and stroke; and honoraria for lectures on these topics; outside the submitted work. He has a patent (US Appl. No. 17/597,213; filed Dec. 29, 2021) pending for smartphone-based stroke diagnosis in patients with dizziness. All other authors have nothing to disclose.