{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:00:37Z","timestamp":1788861637115,"version":"build-2803163510"},"reference-count":117,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"Ministry of Science and Information and Communication Technology","doi-asserted-by":"publisher","award":["RS-2025-00515755"],"award-info":[{"award-number":["RS-2025-00515755"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"Ministry of Science and Information and Communication Technology","doi-asserted-by":"publisher","award":["O2514421"],"award-info":[{"award-number":["O2514421"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100015825","name":"Korea University Anam Hospital","doi-asserted-by":"publisher","award":["RS-2025-00515755"],"award-info":[{"award-number":["RS-2025-00515755"]}],"id":[{"id":"10.13039\/501100015825","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100015825","name":"Korea University Anam Hospital","doi-asserted-by":"publisher","award":["O2514421"],"award-info":[{"award-number":["O2514421"]}],"id":[{"id":"10.13039\/501100015825","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>New-onset vertigo, dizziness and gait imbalance are amongst the most common symptoms presenting to the emergency department, accounting for 2.1\u20134.4% of all patients. The broad spectrum of underlying causes in these patients cuts across many specialties, which often results in diagnostic challenges. For patients meeting the diagnostic criteria for acute vestibular syndrome (AVS, i.e., presenting with acute-onset prolonged vertigo\/dizziness with accompanying gait imbalance, motion intolerance, nausea\/vomiting, with or without nystagmus), the typical differential diagnosis is vertebrobasilar stroke and acute unilateral vestibulopathy. However, other disorders may also present with AVS. These include non-neurological causes such as drug side-effects or intoxication, electrolyte disturbances, cardiac disease, severe anemia, carbon monoxide poisoning, endocrine disorders and others. Other non-stroke neurological disorders may also present with AVS or episodic vertigo\/dizziness, including demyelinating CNS diseases, posterior fossa mass lesions, acute thiamine deficiency and vestibular migraine. Furthermore, acute physiological abnormalities (e.g., hypotension, fever, severe anemia) may unmask previous vestibular impairments that had been well-compensated. Here, we review the diagnostic approach to patients with acute-onset dizziness in the emergency room and discuss the most important differential diagnoses beyond stroke and acute unilateral vestibulopathy.<\/jats:p>","DOI":"10.3390\/brainsci15090995","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T08:56:46Z","timestamp":1758013006000},"page":"995","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Acute Vertigo, Dizziness and Imbalance in the Emergency Department\u2014Beyond Stroke and Acute Unilateral Vestibulopathy\u2014A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8660-7759","authenticated-orcid":false,"given":"Sun-Uk","family":"Lee","sequence":"first","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"}]},{"given":"Jonathan A.","family":"Edlow","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"},{"name":"Emergency Medicine, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6984-6958","authenticated-orcid":false,"given":"Alexander A.","family":"Tarnutzer","sequence":"additional","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"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,15]]},"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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