{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:00:16Z","timestamp":1791252016877,"version":"4.1.0"},"reference-count":82,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T00:00:00Z","timestamp":1736380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Acute vertigo or dizziness is a frequent presentation to the emergency department (ED), making up between 2.1% and 4.4% of all consultations. Given the nature of the ED where the priority is triage, diagnostic delays and misdiagnoses are common, with as many as a third of vertebrobasilar strokes presenting with acute vertigo or dizziness being missed. Here, we review diagnostic errors identified in the evaluation and treatment of the acutely dizzy patient and discuss strategies to overcome them. Lessons learned include focusing on structured history taking, asking about timing and triggers to inform a targeted examination, assessing subtle ocular motor findings (e.g., by use of HINTS(+)), and avoiding overreliance on brain imaging (including early magnetic resonance imaging including diffusion-weighted sequences [DWI-MRI]). Importantly, up to 20% of DWI-MRI may be false negatives if obtained within the first 24\u201348 h after symptom onset. Likewise, overreliance on focal neurologic findings to confirm a stroke diagnosis should be avoided because isolated dizziness, vertigo, or even unsteadiness may be the only symptoms in some patients with vertebrobasilar stroke. Furthermore, in patients with triggered episodic vestibular symptoms provocation maneuvers should be preferred over HINTS(+), and a potential diagnosis of stroke should not be immediately dismissed in younger patients presenting with a headache (where migraine may be more common), but the possibility of a vertebral artery dissection should be further evaluated. Importantly, moderate training of non-experts allows for significant improvement in diagnostic accuracy in the acutely dizzy patient and thus should be prioritized.<\/jats:p>","DOI":"10.3390\/brainsci15010055","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T07:59:42Z","timestamp":1736409582000},"page":"55","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Diagnostic Errors in the Acutely Dizzy Patient\u2014Lessons Learned"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6984-6958","authenticated-orcid":false,"given":"Alexander A.","family":"Tarnutzer","sequence":"first","affiliation":[{"name":"Neurology, Cantonal Hospital of Baden, 5404 Baden, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1545-8527","authenticated-orcid":false,"given":"Nehzat","family":"Koohi","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK"},{"name":"The Ear Institute, University College London, London WC1X 8EE, UK"},{"name":"SENSE Research Unit, Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8660-7759","authenticated-orcid":false,"given":"Sun-Uk","family":"Lee","sequence":"additional","affiliation":[{"name":"Neurotology and Neuro-Ophthalmology Laboratory, Korea University Medical Center, Seoul 02841, Republic of Korea"},{"name":"Department of Neurology, Korea University Medical Center, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0591-646X","authenticated-orcid":false,"given":"Diego","family":"Kaski","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK"},{"name":"SENSE Research Unit, Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"765","DOI":"10.4065\/83.7.765","article-title":"Spectrum of dizziness visits to US emergency departments: Cross-sectional analysis from a nationally representative sample","volume":"83","author":"Hsieh","year":"2008","journal-title":"Mayo Clin. 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