Subscribe to RSS
DOI: 10.1055/a-1908-0353
Schwindel aus neurologischer Sicht
Vertigo from a neurological point of viewAls „Schwindel“ bezeichnen Betroffene eine Vielzahl ursächlich unterschiedlicher Störungen, die von allgemeiner Benommenheit über orthostatische Regulationsstörungen bis hin zu Drehschwindelattacken reichen. Durch eine gezielte Anamnese und klinische Untersuchung kann eine differenzialdiagnostische Eingrenzung erfolgen. Dieser Artikel gibt einen Überblick über die Diagnose und Therapie peripher- und zentral-vestibulärer sowie funktioneller Schwindelsyndrome.
Abstract
Vertigo has many different causal disorders, ranging from general dizziness and orthostatic regulation disorders to attacks of rotary vertigo. A targeted anamnesis and clinical examination can be used to narrow down the differential diagnosis. Questions about the type of dizziness, the duration and accompanying symptoms must be clarified. Various methods are used for differentiation in clinical examinations: the head impulse test, testing of the vertical divergence of the eyes, positioning maneuvers and the ability to stand and walk. But diagnostic imaging is also important. MRI can be used to confirm or rule out vascular causes (cerebral infarction or minor bleeding) and inflammatory lesions. Because the most serious misdiagnosis of dizziness is overlooking a stroke.
Schlüsselwörter
Schwindel - Nystagmus - vestibulär - funktionell - Syndrome - HINTS-Test - Morbus MenièreKeywords
dizziness - nystagmus - vestibular - functional - syndromes - HINTS test - Meniere's diseasePublication History
Article published online:
07 February 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Strupp M, Dlugaiczyk J, Ertl-Wagner BB. et al. Vestibular disorders – diagnosis, new classification and treatment. Dtsch Arztebl Int 2020; 117: 300-310
- 2 Westhofen M, Strupp M. DGHNO-KHC (Hrsg.). et al. S2k-Leitlinie Vestibuläre Funktionsstörungen. AWMF-Register-Nr. 017/078. Accessed November 18, 2022 at: https://register.awmf.org/assets/guidelines/017–078l_S2k_Vestibulaere-Funktionsstoerungen_2021–05.pdf
- 3 Abholz HH, Jendyk R für die Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin. S3-Leitlinie „Akuter Schwindel in der Hausarztpraxis“. AWMF-Register-Nr. 053–018. Accessed November 18, 2022 at: https://register.awmf.org/assets/guidelines/053–018l_S3_Akuter_Schwindel_Hausarztpraxis_2018–07_1-abgelaufen_01.pdf
- 4 Barany-Society. International Classification of Vestibular Disorders. Accessed November 18, 2022 at: https://www.thebaranysociety.org/icvd-consensus-documents/
- 5 Newman-Toker DE, Hsieh YH, Camargo Jr CA. et al. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc 2008; 83: 765-775
- 6 Royl G, Ploner CJ, Leithner C. Dizziness in the emergency room: diagnoses and misdiagnoses. Eur Neurol 2011; 66 (05) 256-263 DOI: 10.1159/000331046. (PMID: 21986277)
- 7 Strupp M, Fischer C, Hanss L. et al. The takeaway frenzel goggles: a fresnel-based device. Neurology 2014; 83: 1241-1245 DOI: 10.1212/WNL.0000000000000838. (PMID: 25165387)
- 8 Halmagyi GM, Curthoys IS. A clinical sign of canal paresis. Arch Neurol 1988; 45: 737-739 DOI: 10.1001/archneur.1988.00520310043015. (PMID: 3390028)
- 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
- 10 Erbguth F. Stroke Mimics und Stroke Chamäleons – Differenzialdiagnose des Schlaganfalls. Fortschr Neurol Psychiatr 2017; 85 (12) 747-764 DOI: 10.1055/s-0043-111889. (PMID: 29212096)
- 11 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 (11) 1080-1088 DOI: 10.1016/j.mayocp.2012.05.023. (PMID: 23063099)
- 12 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 (11) 3504-3510
- 13 Bhattacharyya N, Gubbels SP, Schwartz SR. et al. Clinical practice guideline: benign paroxysmal positional vertigo (Update). Otolaryngol Head Neck Surg 2017; 156 (Suppl. 03) S1-S47 DOI: 10.1177/0194599816689667. (PMID: 28248609)
- 14 Strupp M, Magnusson M. Acute unilateral vestibulopathy. Neurol Clin 2015; 33: 669-685 DOI: 10.3233/VES-220201. (PMID: 35723133)
- 15 Strupp M, Zingler VC, Arbusow V. et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med 2004; 351: 354-361 DOI: 10.1056/NEJMoa033280. (PMID: 15269315)
- 16 Lucieer F, Vonk P, Guinand N. et al. Bilateral vestibular hypofunction: insights in etiologies, clinical sub types, and diagnostics. Front Neurol 2016; 7: 26 DOI: 10.3389/fneur.2016.00026.
- 17 Lempert T, Olesen J, Furman J. et al. Vestibular migraine: diagnostic criteria. J Vestib Res 2012; 22: 167-172 DOI: 10.3233/VES-2012-0453. (PMID: 23142830)
- 18 Maldonado FM, Birdi JS, Irving GJ. et al. Pharmacological agents for the prevention of vestibular migraine. Cochrane Database Syst Rev 2015; 6: CD010600 DOI: 10.1002/14651858.CD010600.pub2.
- 19 Strupp M, Lopez-Escamez JA, Kim JS. et al. Vestibular paroxysmia: diagnostic criteria. J Vestib Res 2016; 26: 409-415 DOI: 10.3233/VES-160589. (PMID: 28262641)
- 20 Staab JP, Eckhardt-Henn A. et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the Committee for the Classification of Vestibular Disorders of the Barany Society. J Vestib Res 2017; 27: 191-208 DOI: 10.3233/VES-170622. (PMID: 29036855)
- 21 Plontke SK, Walther LE. Differenzialdiagnose „Schwindel“. Laryngo-Rhino-Otol 2014; 93: 543-571
- 22 Ward BK, van de Berg R, van Rompaey V. et al. Superior semicircular canal dehiscence syndrome: Diagnostic criteria consensus document of the committee for the classification of vestibular disorders of the Bárány Society. J Vestib Res 2021; 31 (03) 131-141