The state of vestibular neurology: Diagnostic challenges and emerging opportunities

Vestibular neurology has undergone substantial evolution over the past two decades, driven by advances in bedside diagnostics, neuroimaging, computational neuroscience, and therapeutics. Despite this progress, dizziness and vertigo remain among the most common yet diagnostically challenging neurological complaints. This narrative review examines the current state of vestibular neurology, focusing on key clinical syndromes, ongoing diagnostic controversies, and emerging opportunities for innovation. Particular attention is given to acute vestibular syndrome, audiovestibular disorders, bilateral vestibulopathy, functional dizziness, vestibular migraine, and the role of cerebral small vessel disease. In parallel, advances in understanding vestibular contributions to cognition and the development of novel therapeutic strategies, including vestibular implants, neuromodulation, and digital diagnostics, are highlighted. The field is at a pivotal stage, where integration of technology, improved phenotyping, and mechanistic insights promise to transform both diagnosis and management.