Strategy for managing patients with acute vestibular vertigo: decision-making points from the admitting department to the rehabilitation specialist's office

The management of patients with acute vestibular vertigo (AVV) remains a difficult and pressing problem in modern medicine due to the variety of aetiological factors, the subjective nature of patient complaints, and the insufficient application of existing neurovestibular diagnostic algorithms in real clinical practice. Despite the large number of publications on the management of patients with AVV, certain issues regarding the examination and routing of patients remain unresolved to this day. Approximately a quarter of conditions manifested by AVV are caused by stroke or other life-threatening diseases, therefore emergency diagnosis is always necessary. Due to the insufficient informativeness of neuroimaging methods in patients with isolated vestibular vertigo, clinical diagnosis comes to the fore, requiring special training from doctors. Patients with peripheral causes of acute vestibular syndrome and vestibular migraine often do not receive fully effective treatment and recommendations for further rehabilitation in neurological hospitals, which makes an initially benign cause a trigger for chronic complaints of vertigo, leading to various functional disorders that slow down recovery, cause disability, and significantly reduce patients' quality of life. On 22 November 2025, a council of experts was held to discuss important issues related to the diagnosis, management and rehabilitation of patients with AVV, resulting in a proposed strategy for patient management.