Acute vestibular syndrome in the practice of an otorhinolaryngologist: issues and solutions

Acute vestibular syndrome (AVS) is a complex symptom constellation that can result from lesions affecting both central and peripheral vestibular structures. This article provides an overview of the various conditions that may present under the guise of AVS, including ischemic events in the territory of the anterior inferior cerebellar artery (AICA) or posterior inferior cerebellar artery (PICA), vestibular neuritis, Ramsay Hunt syndrome, the initial attack of Ménière’s disease, vestibular migraine, autoimmune inner ear disease, labyrinthitis, and vestibular schwannoma. The diagnostic challenges posed by this heterogeneous group of disorders highlight the critical importance of bedside clinical assessment in making an accurate differential diagnosis. The review explores established clinical protocols used for distinguishing between central and peripheral causes of AVS. Protocols discussed include the HINTS exam (Head Impulse, Nystagmus, Test of Skew) as well as the extended HINTS-plus protocol, which incorporates Functional Hearing Assessment. Additional diagnostic tools, such as the ABCD2 score (Age, Blood Pressure, Clinical Features, Duration of Symptoms, Diabetes) and the STANDING protocol, are also reviewed. The article further examines the sensitivity of neuroimaging modalities, particularly brain CT and MRI, in the evaluation of central versus peripheral vestibulopathies. Emerging diagnostic technologies, such as the video head impulse test (vHIT), which assesses vestibulo-ocular reflex (VOR) impairment and its prognostic implications, are also discussed. Moreover, the potential role of biomarkers, including neurospecific proteins such as S100β and neuron-specific enolase (NSE), in the assessment and diagnosis of AVS are highlighted for their potential to serve as indicators of neuronal and glial damage. Keywords: acute vestibular syndrome, vestibular neuritis, video pulse test, autoimmune inner ear disease. For citation: Kunelskaya N.L., Zaoeva Z.O., Manaenkova E.A., Baibakova E.V., Chugunova M.A., Yanyushkina E.S., Nikitkina Ya.Yu. Acute vestibular syndrome in the practice of an otorhinolaryngologist: issues and solutions. RMJ. 2025;1:33–36. DOI: 10.32364/2225-2282-2025-1-7