Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome

izziness is the third most common major medical symptom reported in general medical clinics 1 and accounts for about 3%-5% of visits across care settings. In the United States, this translates to 10 million ambulatory visits per year because of dizziness, 3 with roughly 25% of these visits to emergency departments. 2 Many patients have transient or episodic symptoms that last seconds, minutes or hours, but some have prolonged dizziness that persists continuously for days to weeks. n this article, we use the term "dizziness" to encompass vertigo, presyncope, unsteadi ness, and other nonspecific forms of dizziness. When dizziness de velops acutely, is accompanied by nausea or vomiting, unsteady gait, nystagmus and intolerance to head motion, and persists for a day or more, the clinical condition is known as acute vestibular syndrome. We define isolated acute vestibular syndrome (with or without hearing loss) as occurring in the absence of focal