SYSTEMATIC APPROACH

C-AVS or P-AVS/C-EVS or P-EVS/C-CVS or P-CVS

CENTRAL or PERIPHERAL SIGN

START 03

Stroke/BPPV/Meniere’s etc
SPECIFIC ETIOLOGY
04

01 02

VESTIBULAR SYMPTOMS VESTIBULAR SYNDROMES

Vertigo/Vestibulo-visual Symptom/ AVS/EVS/CVS
Dizziness/Postural Symptom
VESTIBULAR SYMPTOM
(ICVD CLASSIFICATION)
VESTIBULAR SYNDROME
HISTORY TAKING
PHYSICAL EXAMINATION
All Vestibular Syndrome Examination
 Acute Vestibular Syndrome Examination

Other nystagmus suggestive central origin

Any of the HINTS-plus findings suggestive of central
→ consider central origin until proven otherwise

If HINTS-plus is still inconclusive or to increase Sn/Sp

→perform postural balance, coordination & central
oculomotor examination
Episodic Vestibular Syndrome Triggered Examination
Alternative Algorithm
in Acute Vertigo
Episodic Vestibular Syndrome Spontaneous
and Chronic Vestibular Syndrome
COMMON VESTIBULAR DISORDERS