Patients presenting to the ER are diverse with regard to presenting symptoms, underlying pathologies, pre-existing conditions, age and socioeconomic background. VD may present as acute vestibular syndrome (AVS) in unilateral vestibular dysfunction (peripheral or central), but other diagnoses have to be kept in mind from benign paroxysmal positional vertigo (BPPV) to anxiety related dizziness. In neurological ER services, VD accounts for > 10% of patients and is the third most common leading symptom after headache (20%) and motor deficit (13%), respectively, after cerebrovascular disorders (28%) and headache (22%). Vertigo and dizziness (VD) are among the most frequent symptoms reported by patients at ER consultations. The diagnostic algorithm varies according to the leading symptoms upon presentation and possible differential diagnoses. Patients presenting to the emergency room (ER) must be diagnosed quickly to identify those needing urgent treatment. However, it is likely that multiple factors contribute to the fluctuations that have to be disentangled in further studies. The BPPV peak in winter might be related to reduced physical activity and low vitamin D. The UVH peak in autumn supports the viral origin of the condition (vestibular neuritis). Seasonal presentation revealed interesting fluctuations. In summary, daytime of presentation did not distinguish between diagnoses as most patients presented during normal working hours. Finally, functional/psychogenic VD was common in summer and autumn with highest numbers in September/October and lowest numbers in March. UVH was most often seen in October/November absolute and relative numbers were lowest in August. BPPV was most prevalent in December/January and rare in September. There are, however, seasonal differences. Irrespective of the diagnosis, the majority of patients presented to the ER between 8 a.m. The most frequent-specific diagnoses were BPPV (19.9%), stroke/transient ischemic attack (12.5%), acute unilateral vestibulopathy/vestibular neuritis (UVH 8.3%), and functional VD (8.3%). In the ER 4.23% of all patients presented with VD (818 out of 19,345). A retrospective chart analysis of all patients seen in a one-year period was performed. The objective of the present study was to analyze frequency and distribution patterns of specific vestibular and non-vestibular diagnoses in an interdisciplinary university emergency room (ER), including data on daytime and season of presentation. A number of clues from patient history and clinical examination, including several diagnostic index tests have been reported recently. Distinguishing between serious (e.g., stroke) and benign (e.g., benign paroxysmal positional vertigo, BPPV) disorders remains challenging in emergency consultations for vertigo and dizziness (VD).
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