Presbyvestibulopathie

Zusammenfassung

In dieser Publikation werden die Diagnosekriterien für Presbyvestibulopathie (PVP) durch das Klassifikationskomitee der Bárány-Gesellschaft beschrieben. PVP ist als ein chronisches vestibuläres Syndrom definiert, das durch Gangunsicherheit, Gangstörungen und/oder wiederholte Stürze bei leichten bilateralen vestibulären Defiziten gekennzeichnet ist, mit Labortestbefunden, die zwischen Normalwerten und Schwellenwerten für die bilaterale Vestibulopathie liegen.

Die Diagnose von PVP basiert auf der Anamnese des Patienten, der körperlichen Untersuchung des Patienten und der Auswertung von Untersuchungen des Gleichgewichtssystems. Die Diagnose von PVP setzt eine bilateral verminderte Funktion des vestibulookulären Reflexes (VOR) voraus. Dies kann für den Hochfrequenzbereich des VOR mit dem Video-Kopf-Impuls-Test (vKIT), für den mittleren Frequenzbereich mit dem Drehstuhltest und für den Niederfrequenzbereich mit der kalorischen Prüfung diagnostiziert werden.

Für die Diagnose von PVP sollte der horizontale anguläre VOR-Verstärkungsfaktor (Gain) auf beiden Seiten < 0,8 und > 0,6 betragen, und/oder die Summe der maximalen Spitzengeschwindigkeiten in der langsamen Phase des kalorisch induzierten Nystagmus sollte bei der Stimulation mit warmem und kaltem Wasser auf jeder Seite < 25°/s und > 6°/s betragen, und/oder der horizontale anguläre VOR-Gain sollte bei Drehstuhlpendelung > 0,1 und < 0,3 betragen.

PVP tritt typischerweise zusammen mit anderen altersbedingten Defiziten des Sehvermögens, der Propriozeption und/oder der kortikalen, zerebellären und extrapyramidalen Funktion auf, die ebenfalls zur Manifestation der Symptome von Gangunsicherheit, Gangstörungen und Stürzen beitragen und diese möglicherweise erst auftreten lassen. Die hier beschriebenen Kriterien berücksichtigen lediglich das Vorhandensein dieser Symptome zusammen mit einer dokumentierten Beeinträchtigung der vestibulären Funktion bei älteren Erwachsenen.

Abstract

This paper describes the diagnostic criteria for presbyvestibulopathy (PVP) by the Classification Committee of the Bárány Society. PVP is defined as a chronic vestibular syndrome characterized by unsteadiness, gait disturbance, and/or recurrent falls in the presence of mild bilateral vestibular deficits, with findings on laboratory tests that are between normal values and thresholds established for bilateral vestibulopathy. The diagnosis of PVP is based on the patient history, bedside examination and laboratory evaluation. The diagnosis of PVP requires bilaterally reduced function of the vestibulo-ocular reflex (VOR). This can be diagnosed for the high frequency range of the VOR with the video-HIT (vHIT); for the middle frequency range with rotary chair testing; and for the low frequency range with caloric testing. For the diagnosis of PVP, the horizontal angular VOR gain on both sides should be < 0.8 and > 0.6, and/or the sum of the maximal peak velocities of the slow phase caloric-induced nystagmus for stimulation with warm and cold water on each side should be < 25°/s and > 6°/s, and/or the horizontal angular VOR gain should be > 0.1 and < 0.3 upon sinusoidal stimulation on a rotatory chair.

PVP typically occurs along with other age-related deficits of vision, proprioception, and/or cortical, cerebellar and extrapyramidal function which also contribute and might even be required for the manifestation of the symptoms of unsteadiness, gait disturbance, and falls. These criteria simply consider the presence of these symptoms, along with documented impairment of vestibular function, in older adults.

Schlüsselwörter

Presbyvestibulopathie - Diagnosekriterien - Schwindel

Key words

Presbyvestibulopathy - diagnostic criteria - dizziness

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