The Diagnostic Dilemma of Acute Vestibular Syndrome: Why HINTS Outperforms Diffusion-weighted magnetic resonance imaging?

This is the authors' abstract. We don't add key points for this paper.

OBJECTIVES: To evaluate the diagnostic approaches, specifically the comparative accuracy of bedside clinical examinations versus early neuroimaging, in differentiating central from peripheral causes of Acute Vestibular Syndrome (AVS). METHODS: A comprehensive narrative literature review was conducted utilizing established scientific databases, including PubMed/Medline, Scopus, Web of Science, and Embase, covering articles published up to 2024. A structured search strategy was applied using keywords such as "Acute Vestibular Syndrome", "Central vestibular dysfunction", "Peripheral vestibular dysfunction", and "HINTS protocol". Peer-reviewed clinical trials, mechanistic studies, and authoritative guidelines were included to synthesize the current evidence regarding the diagnosis and management of acute vertigo. RESULTS: The synthesis of the literature reveals that targeted bedside neuro-otological examinations demonstrate superior sensitivity (96.8%) and specificity (98.5%) compared to early "Diffusion-weighted magnetic resonance imaging" in detecting posterior circulation strokes within the initial 48 hours. Early neuroimaging frequently yields false-negative results in up to 14.3% of ischemic events. CONCLUSION: Accurate differentiation of etiologies in continuous vertigo relies heavily on structured bedside clinical assessments rather than immediate neuroimaging. Implementing these clinical protocols prevents severe neurological sequelae from missed posterior fossa strokes while simultaneously avoiding unnecessary healthcare expenditures for benign peripheral conditions.