Download PDF
Dtsch Med Wochenschr 2019; 144(12): 821-829
DOI: 10.1055/a-0746-4425
Dossier
© Georg Thieme Verlag KG Stuttgart · New York

Diagnose und Differenzialdiagnose von peripheren und zentralen Schwindelsyndromen

Diagnosis and Differential Diagnosis of Peripheral and Central Vestibular Disorders
Michael Strupp
,
Katharina Feil
,
Andreas Zwergal
Further Information

Publication History

Publication Date:
18 June 2019 (online)

Also available at
    Permissions and Reprints

Abstract

The diagnosis of the various peripheral and central vestibular disorders is mainly based on the patient history (time course, type of symptoms, modulating factors, and accompanying symptoms) and a systematic clinical examination of the vestibular, ocular motor, and cerebellar systems (examination for nystagmus, head impulse test, positional maneuvers, Romberg test and examination for central ocular motor signs). The two most important laboratory tests are the “video-head impulse test” and caloric irrigation. Fortunately, the diagnosis of vestibular disorders has become easier and more precise as a result of the very clinically oriented diagnostic criteria of the Bárány Society (www.jvr-web.org/ICVD.html).

Die Diagnose der verschiedenen peripheren und zentralen Schwindelsyndrome basiert auf einer systematischen Anamnese und kombinierten klinischen Untersuchung der vestibulären, okulomotorischen und zerebellären Systeme. Die wichtigsten apparativen diagnostischen Verfahren sind der Video-Kopfimpulstest und die kalorische Testung. Die Diagnosestellung ist durch die neuen Diagnosekriterien der Bárány Society vereinfacht worden (www.jvr-web.org/ICVD.html).

Schlüsselwörter

Drehschwindel - Schwankschwindel - Gangunsicherheit - Nystagmus - Kleinhirn

Key words

vertigo - dizziness - imbalance - nystagmus - cerebellum
 

  • Literatur

  • 1 Corrales CE, Bhattacharyya N. Dizziness and death: An imbalance in mortality. Laryngoscope 2016; 126: 2134-2136
    CrossrefPubMedGoogle Scholar
  • 2 Neuhauser HK. The epidemiology of dizziness and vertigo. Handb Clin Neurol 2016; 137: 67-82
    CrossrefPubMedGoogle Scholar
  • 3 Feuerecker R, Habs M, Dieterich M. et al. Chronic subjective dizziness: Fewer symptoms in the early morning – a comparison with bilateral vestibulopathy and downbeat nystagmus syndrome. J Vestib Res 2015; 25: 67-72
    CrossrefPubMedGoogle Scholar
  • 4 Strupp M, Fischer C, Hanss L. et al. The takeaway Frenzel goggles: a Fresnel-based device. Neurology 2014; 83: 1241-1245
    CrossrefPubMedGoogle Scholar
  • 5 Yip CW, Glaser M, Frenzel C. et al. Comparison of the bedside head-impulse test with the video head-impulse test in a clinical practice setting: a prospective study of 500 outpatients. Front Neurol 2016; 7: 58
    PubMedGoogle Scholar
  • 6 Dieterich M. Central vestibular disorders. J Neurol 2007; 254: 559-568
    CrossrefPubMedGoogle Scholar
  • 7 Zwergal A, Rettinger N, Frenzel C. et al. A bucket of static vestibular function. Neurology 2009; 72: 1689-1692
    CrossrefPubMedGoogle Scholar
  • 8 Buttner U, Helmchen C, Brandt T. Diagnostic criteria for central versus peripheral positioning nystagmus and vertigo: a review. Acta Otolaryngol 1999; 119: 1-5
    CrossrefPubMedGoogle Scholar
  • 9 Cnyrim CD, Newman-Toker D, Karch C. et al. Bedside differentiation of vestibular neuritis from central “vestibular pseudoneuritis”. J Neurol Neurosurg Psychiatry 2008; 79: 458-460
    CrossrefPubMedGoogle Scholar
  • 10 Fife TD, Colebatch JG, Kerber KA. et al. Practice guideline: Cervical and ocular vestibular evoked myogenic potential testing: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2017; 89: 2288-2296
    CrossrefPubMedGoogle Scholar
  • 11 Saber Tehrani AS, Kattah JC, Kerber KA. et al. Diagnosing Stroke in Acute Dizziness and Vertigo: Pitfalls and Pearls. Stroke 2018; 49: 788-795
    CrossrefPubMedGoogle Scholar
  • 12 Strupp M, Kim JS, Murofushi T. et al. Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Barany Society. J Vestib Res 2017; 27: 177-189
    CrossrefPubMedGoogle Scholar
  • 13 von Brevern M, Bertholon P, Brandt T. et al. Benign paroxysmal positional vertigo: Diagnostic criteria. J Vestib Res 2015; 25: 105-117
    CrossrefPubMedGoogle Scholar
  • 14 Lopez-Escamez JA, Carey J, Chung WH. et al. Diagnostic criteria for Meniere’s disease. J Vestib Res 2015; 25: 1-7
    CrossrefPubMedGoogle Scholar
  • 15 Strupp M, Lopez-Escamez JA, Kim JS. et al. Vestibular paroxysmia: diagnostic criteria. J Vestib Res 2016; 26: 409-415
    CrossrefPubMedGoogle Scholar
  • 16 Navi BB, Kamel H, Shah MP. et al. Rate and predictors of serious neurologic causes of dizziness in the emergency department. Mayo Clin Proc 2012; 87: 1080-1088
    CrossrefPubMedGoogle Scholar
  • 17 Lee H, Sohn SI, Cho YW. et al. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology 2006; 67: 1178-1183
    CrossrefPubMedGoogle Scholar
  • 18 Kattah JC, Talkad AV, Wang DZ. et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40: 3504-3510
    CrossrefPubMedGoogle Scholar
  • 19 Lempert T, Olesen J, Furman J. et al. Vestibular migraine: diagnostic criteria. J Vestib Res 2012; 22: 167-172
    CrossrefPubMedGoogle Scholar
  • 20 Feil K, Strobl R, Schindler A. et al. What is behind cerebellar vertigo and dizziness?. Cerebellum. 2018 [Epub ahead of print]
    PubMedGoogle Scholar
  • 21 Strupp M, Teufel J, Zwergal A. et al. Aminopyridines for the treatment of neurologic disorders. Neurol Clin Pract 2017; 7: 65-76
    CrossrefPubMedGoogle Scholar
  • 22 Jen JC, Wan J. Episodic ataxias. Handb Clin Neurol 2018; 155: 205-215
    Google Scholar
  • 23 Kalla R, Deutschlander A, Hufner K. et al. Detection of floccular hypometabolism in downbeat nystagmus by fMRI. Neurology 2006; 66: 281-283
    CrossrefPubMedGoogle Scholar