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

BACKGROUND: Vertigo and dizziness are common in the emergency room, caused by a broad spectrum of conditions ranging 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 performed, 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, complementing standard clinical assessment. It facilitates early recognition of functional dizziness and may reduce underdiagnosis and prolonged symptom chronification.