Acute vertigo and dizziness: the diagnostic potential of static posturography in the neurological emergency department

Abstract

Background Vertigo and dizziness are common in the emergency room, caused by a broad spectrum of conditions rang ing from life-threatening to non-organic causes such as functional dizziness. The latter is often underdiagnosed, leading to chronic symptoms and high costs. Objective To evaluate the diagnostic value of a short dual-task static posturography (sPG) protocol in patients with acute vertigo and dizziness in the neurological emergency department. Methods We prospectively assessed 211 patients using sPG. Established patterns (normal, functional, cerebellar, sensory ataxic) were rated on a 5-point scale by two blinded experts. Interrater agreement and non-parametric analyses were per formed, and diagnostic classifications were compared with and without sPG. Results Interrater agreement was high (Kappa = 0.965). sPG identified functional patterns in 29.3% of previously unclear vertigo/dizziness cases, leading to a highly significant increase in the diagnosis of functional dizziness (p < 0.001). Functional patterns were also frequently observed in organic diagnoses, particularly in episodic vestibular disorders. Furthermore, by detecting cerebellar patterns, sPG identified 20% more cases of central vestibular disorders (from 45 to 54 cases). Conclusion sPG offers a rapid, cost-effective tool to identify functional dizziness in the emergency setting, complement ing standard clinical assessment. It facilitates early recognition of functional dizziness and may reduce underdiagnosis and prolonged symptom chronification.