Vascular vertigo and dizziness: diagnostic criteria
Reviewed by Victor Osei-Lah

This diagnostic criteria is one of the latest produced by The Bárány Society. It is a useful addition to previous ones for vestibular disorders. Vascular vertigo/dizziness by definition is caused by stroke, transient ischaemic attack (TIA), isolated labyrinthine infarction/haemorrhage and vertebral artery compression syndrome (VACS). The authors use vertigo and dizziness together but, for the purpose of this summary, only ‘vertigo’ will be used. Criterion C is the same for all classifications except for VACS. In acute prolonged vascular vertigo, criteria A-C must apply: A. acute vertigo, dizziness, or unsteadiness lasting for 24 hours or more; B. imaging evidence of ischemia or haemorrhage in the brain or inner ear, which corresponds to the symptoms, signs and findings; and C. not better accounted for by another disease or disorder. For probable acute vascular vertigo, criteria A and C are the same, at least one of the following, B, must apply: 1. focal central neurological symptoms and signs, e.g. hemiparesis, sensory loss, dysarthria, dysphagia, or severe truncal ataxia/postural instability; 2. at least one component of central HINTS (normal head impulse test, direction-changing gaze-evoked nystagmus, or pronounced skew deviation); and 3. other central ocular motor abnormalities, e.g. central nystagmus, impaired saccades, or impaired smooth pursuit; 4. increased risk for vascular events (e.g. ABCD2 score of four or more, or atrial fibrillation). A diagnosis of probable acute vertigo in evolution can be made if the following are fulfilled: A. acute spontaneous vertigo, dizziness, or unsteadiness for more than three hours, but that has not yet lasted for at least 24 hours when seen, criterion C and at least one of B above which has been expanded to include new onset of moderate to severe craniocervical pain or significant (> 50%) narrowing of an artery of the vertebrobasilar system. Transient vascular vertigo/acute vertigo in evolution must fulfil all A-C as follows: A. acute spontaneous vertigo, dizziness, or unsteadiness lasting less than 24 hours; B. imaging evidence of ischemia or haemorrhage in the brain or inner ear, which corresponds to the symptoms, signs and findings. Probable transient vascular vertigo is diagnosed by A. acute spontaneous vertigo, dizziness, or unsteadiness lasting less than 24 hours; B. at least one of the following: 1. focal central neurological symptoms or severe postural instability during the attack; 2. new onset of moderate to severe craniocervical pain during the attack; 3. increased risk for vascular events, e.g. ABCD2 score of four or more, or atrial fibrillation; 4. significant (> 50%) narrowing of an artery of the vertebrobasilar system and C. Finally, in vertebral artery compression syndrome, A-D must be met: A. vertigo with or without tinnitus provoked by a sustained eccentric neck position, especially in an upright body position; B. presence of nystagmus with the symptoms during an attack; C. either documentation of VA compression using dynamic angiography or demonstration of decreased blood flow in the posterior circulation using transcranial Doppler during the provoking head motion; D. not better accounted for by another disease or disorder. The accompanying detailed notes, site of lesion guide, epidemiology, examination and investigations provide in-depth information on vascular vertigo, which I highly recommend.

Vascular vertigo and dizziness: Diagnostic criteria.
Kim JS, Newman-Toker DE, Kerber KA, et al.
J VESTIB RES
2022;32(3):205-22.