Subscribe to RSS
DOI: 10.1055/a-1933-0731
Nicht zervikogener Schwindel, sondern Benigner Paroxysmaler Lagerungsschwindel
Not Cervicogenic Vertigo, but Benign Paroxysmal Positional VertigoZusammenfassung
Patient*innen, die sich mit der Diagnose „Zervikogener Schwindel“ in der physiotherapeutischen Praxis vorstellen, sind in einigen Fällen fehldiagnostiziert und leiden eigentlich unter einem gutartigen Lagerungsschwindel. Oft stellt sich dabei die Frage: Wie wird ein benigner paroxysmaler Lagerungsschwindel (BPLS) erkannt und erfolgreich behandelt? In diesem Artikel werden die Grundlagen des BPLS und des zervikogenen Schwindels dargestellt und aufgezeigt, wie diese differenziert werden können. Anhand dreier exemplarischer Fallbeispiele von Patient*innen mit der Diagnose „Zervikogener Schwindel“ wird dargelegt, wie Physiotherapeut*innen mittels Anamnese und hypothesengesteuerter Untersuchung einen BPLS identifizieren und mit entsprechendem Manöver erfolgreich behandeln können. Ein BPLS erfordert andere Behandlungstechniken als ein zervikogener Schwindel und benötigt in der Regel nur wenige Sitzungen.
Abstract
Patients who present to the physiotherapist’s practice with the diagnosis of “cervicogenic vertigo” have in some cases been misdiagnosed and actually suffer from benign paroxysmal positional vertigo (BPPV). This often gives rise the question: How can BPPV be detected and treated successfully? This article presents the basics of benign paroxysmal positional vertigo and cervicogenic vertigo and shows how they can be differentiated. Using 3 exemplary case studies of patients diagnosed with “cervicogenic vertigo”, the article shows how physiotherapists can identify BPPV through anamnesis and hypothesis-driven examination and successfully treat it with appropriate maneuvers. BPPV requires different treatment techniques than cervicogenic vertigo and, as a rule, only a few therapy sessions are needed.
Publication History
Received: 10 April 2022
Accepted: 12 May 2022
Article published online:
07 December 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 von Brevern M, Radtke A, Lezius F. et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007; 78: 710-715 jnnp.2006.100420 [pii]10.1136/jnnp.2006.100420
- 2 Neuhauser HK, Radtke A, von Brevern M. et al. Burden of dizziness and vertigo in the community. Arch Intern Med 2008; 168: 2118-2124 DOI: 10.1001/archinte.168.19.2118.
- 3 Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Neurology 1996; 46: 1470 DOI: 10.1212/wnl.46.5.1470.
- 4 Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ 2003; 169: 681-693
- 5 Leopardi G, Chiarella G, Serafini G. et al. Paroxysmal positional vertigo: short- and long-term clinical and methodological analyses of 794 patients. Acta Otorhinolaryngol Ital 2003; 23: 155-160
- 6 Pagnini P, Nuti D, Vannucchi P. Benign paroxysmal vertigo of the horizontal canal. ORL J Otorhinolaryngol Relat Spec 1989; 51: 161-170 DOI: 10.1159/000276052.
- 7 Escher A, Ruffieux C, Maire R. Efficacy of the barbecue manoeuvre in benign paroxysmal vertigo of the horizontal canal. Eur Arch Otorhinolaryngol 2007; 264: 1239-1241 DOI: 10.1007/s00405-007-0337-6.
- 8 Cakir BO, Ercan I, Cakir ZA. et al. What is the true incidence of horizontal semicircular canal benign paroxysmal positional vertigo?. Otolaryngol Head Neck Surg 2006; 134: 451-454 DOI: 10.1016/j.otohns.2005.07.045.
- 9 Kollén L, Frändin K, Möller M. et al. Benign paroxysmal positional vertigo is a common cause of dizziness and unsteadiness in a large population of 75-year-olds. Aging Clin Exp Res 2012; 24: 317-323 DOI: 10.1007/BF03325263.
- 10 Baloh RW, Honrubia V, Jacobson K. Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology 1987; 37: 371-378
- 11 Mandalà M, Santoro GP, Awrey J. et al. Vestibular neuritis: recurrence and incidence of secondary benign paroxysmal positional vertigo. Acta Otolaryngol 2010; 130: 565-567 DOI: 10.3109/00016480903311278.
- 12 Nedzelski JM, Barber HO, McIlmoyl L. Diagnoses in a dizziness unit. J Otolaryngol 1986; 15: 101-104
- 13 Balatsouras DG, Ganelis P, Aspris A. et al. Benign paroxysmal positional vertigo associated with Meniere’s disease: epidemiological, pathophysiologic, clinical, and therapeutic aspects. Ann Otol Rhinol Laryngol 2012; 121: 682-688 DOI: 10.1177/000348941212101011.
- 14 Gross EM, Ress BD, Viirre ES. et al. Intractable benign paroxysmal positional vertigo in patients with Meniere’s disease. Laryngoscope 2000; 110: 655-659 DOI: 10.1097/00005537-200004000-00022.
- 15 Katsarkas A. Benign paroxysmal positional vertigo (BPPV): idiopathic versus post-traumatic. Acta Otolaryngol 1999; 119: 745-749 DOI: 10.1080/00016489950180360.
- 16 Motin M, Keren O, Groswasser Z. et al. Benign paroxysmal positional vertigo as the cause of dizziness in patients after severe traumatic brain injury: diagnosis and treatment. Brain Inj 2005; 19: 693-697 DOI: 10.1080/02699050400013600.
- 17 Jeong SH, Kim JS, Shin JW. et al. Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol 2013; 260: 832-838 DOI: 10.1007/s00415-012-6712-2.
- 18 Yamanaka T, Shirota S, Sawai Y. et al. Osteoporosis as a risk factor for the recurrence of benign paroxysmal positional vertigo. Laryngoscope 2013; 123: 2813-2816 DOI: 10.1002/lary.24099.
- 19 Vibert D, Kompis M, Häusler R. Benign paroxysmal positional vertigo in older women may be related to osteoporosis and osteopenia. Ann Otol Rhinol Laryngol 2003; 112: 885-889 DOI: 10.1177/000348940311201010.
- 20 Jeong SH, Choi SH, Kim JY. et al. Osteopenia and osteoporosis in idiopathic benign positional vertigo. Neurology 2009; 72: 1069-1076 DOI: 10.1212/01.wnl.0000345016.33983.e0.
- 21 Jang YS, Kang MK. Relationship between bone mineral density and clinical features in women with idiopathic benign paroxysmal positional vertigo. Otol Neurotol 2009; 30: 95-100 DOI: 10.1097/MAO.0b013e31818f5777.
- 22 Parham K, Leonard G, Feinn RS. et al. Prospective clinical investigation of the relationship between idiopathic benign paroxysmal positional vertigo and bone turnover: a pilot study. Laryngoscope 2013; 123: 2834-2839 DOI: 10.1002/lary.24162.
- 23 Yu S, Liu F, Cheng Z. et al. Association between osteoporosis and benign paroxysmal positional vertigo: a systematic review. BMC Neurol 2014; 14: 110 DOI: 10.1186/1471-2377-14-110.
- 24 Lee WK, Koh SW, Wee SK. Benign paroxysmal positional vertigo in people with traumatic spinal cord injury: incidence, treatment efficacy and implications. Am J Otolaryngol 2012; 33: 723-730 DOI: 10.1016/j.amjoto.2012.06.008.
- 25 Schädler S. Gleichgewicht und Schwindel, Grundlagen – Untersuchung – Therapie. 2. Aufl. München: Elsevier, Urban & Fischer; 2022
- 26 Gärtner M. Klinik und Therapie des benignen Lagerungsschwindels. Ein Leitfaden für die Praxis von Dr. med. M . Gärtner, Leiter Neuro-Ontologie und Erwachsenen Audiologie HNO-Klnik, Kantonspital Luzern. Bern: Solvay Pharma AG; 2009
- 27 Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev 2014; CD003162 DOI: 10.1002/14651858.CD003162.pub3.
- 28 Mandalà M, Santoro GP, Asprella Libonati G. et al. Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo. J Neurol 2012; 259: 882-885 DOI: 10.1007/s00415-011-6272-x.
- 29 Levrat E, van Melle G, Monnier P. et al. Efficacy of the Semont maneuver in benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 2003; 129: 629-633 DOI: 10.1001/archotol.129.6.629.
- 30 Radtke A, von Brevern M, Tiel-Wilck K. et al. Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure. Neurology 2004; 63: 150-152 DOI: 10.1212/01.wnl.0000130250.62842.c9.
- 31 Schädler S. Fehldiagnosen und Fehlbehandlungen bei benignem paroxysmalen Lagerungsschwindel (BPLS). Forum HNO 2022; 1: 30-36
- 32 Fife TD, Iverson DJ, Lempert T. et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2008; 70: 2067-2074 DOI: 10.1212/01.wnl.0000313378.77444.ac.
- 33 Bhattacharyya N, Gubbels SP, Schwartz SR. et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg 2017; 156: S1-S47 DOI: 10.1177/0194599816689667.
- 34 Ramos BF, Cal R, Brock CM. et al. Apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo: Where are the particles?. Audiol Res 2019; 9: 228 DOI: 10.4081/audiores.2019.228.
- 35 Fransson PA, Karlberg M, Sterner T. et al. Direction of galvanically-induced vestibulo-postural responses during active and passive neck torsion. Acta Otolaryngol 2000; 120: 500-503 DOI: 10.1080/000164800750045992.
- 36 von Brevern M, Bertholon P, Brandt T. et al. Benign paroxysmal positional vertigo: Diagnostic criteria Consensus document of the Committee for the Classification of Vestibular Disorders of the Barany Society. Acta Otorrinolaringol Esp (Engl Ed) 2017; 68: 349-360 DOI: 10.1016/j.otorri.2017.02.007.
- 37 Fife TD. Recognition and management of horizontal canal benign positional vertigo. Am J Otol 1998; 19: 345-351
- 38 Argaet EC, Bradshaw AP, Welgampola MS. Benign positional vertigo, its diagnosis, treatment and mimics. Clin Neurophysiol Pract 2019; 4: 97-111 DOI: 10.1016/j.cnp.2019.03.001.
- 39 Reid SA, Rivett DA. Manual therapy treatment of cervicogenic dizziness: a systematic review. Man Ther 2005; 10: 4-13 DOI: 10.1016/j.math.2004.03.006.
- 40 Reiley AS, Vickory FM, Funderburg SE. et al. How to diagnose cervicogenic dizziness. Arch Physiother 2017; 7: 12 DOI: 10.1186/s40945-017-0040-x.
- 41 Wrisley DM, Sparto PJ, Whitney SL. et al. Cervicogenic dizziness: a review of diagnosis and treatment. J Orthop Sports Phys Ther 2000; 30: 755-766 DOI: 10.2519/jospt.2000.30.12.755.
- 42 Devaraja K. Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management. Eur Arch Otorhinolaryngol 2018; 275: 2421-2433 DOI: 10.1007/s00405-018-5088-z.
- 43 Bronstein AM, Hood JD. The cervico-ocular reflex in normal subjects and patients with absent vestibular function. Brain Res 1986; 373: 399-408 DOI: 10.1016/0006-8993(86)90355-0.
- 44 Heimbrand S, Bronstein AM, Gresty MA. et al. Optically induced plasticity of the cervico-ocular reflex in patients with bilateral absence of vestibular function. Exp Brain Res 1996; 112: 372-380 DOI: 10.1007/BF00227943.
- 45 Huygen PL, Verhagen WI, Nicolasen MG. Cervico-ocular reflex enhancement in labyrinthine-defective and normal subjects. Exp Brain Res 1991; 87: 457-464 DOI: 10.1007/BF00231863.
- 46 Kelders WPA, Kleinrensink GJ, van der Geest JN. et al. Compensatory increase of the cervico-ocular reflex with age in healthy humans. J Physiol 2003; 553: 311-317 DOI: 10.1113/jphysiol.2003.049338.
- 47 Lennerstrand G, Han Y, Velay JL. Properties of eye movements induced by activation of neck muscle proprioceptors. Graefes Arch Clin Exp Ophthalmol 1996; 234: 703-709 DOI: 10.1007/BF00292357.
- 48 Strupp M, Arbusow V, Dieterich M. et al. Perceptual and oculomotor effects of neck muscle vibration in vestibular neuritis. Ipsilateral somatosensory substitution of vestibular function. Brain 1998; 121: 677-685 DOI: 10.1093/brain/121.4.677.
- 49 Alund M, Ledin T, Odkvist L. et al. Dynamic posturography among patients with common neck disorders. A study of 15 cases with suspected cervical vertigo. J Vestib Res 1993; 3: 383-389
- 50 Hlavacka F, Njiokiktjien C. Postural responses evoked by sinusoidal galvanic stimulation of the labyrinth. Influence of head position. Acta Otolaryngol 1985; 99: 107-112 DOI: 10.3109/00016488509119152.
- 51 Lund S. Postural effects of neck muscle vibration in man. Experientia 1980; 36: 1398 DOI: 10.1007/BF01960120.
- 52 Wyke B. Cervical articular contribution to posture and gait: their relation to senile disequilibrium. Age Ageing 1979; 8: 251-258
- 53 Hülse M, Hölzl M. Vestibulospinal reactions in cervicogenic disequilibrium. Cervicogenic imbalance. [Article in German] HNO 2000; 48: 295-301 DOI: 10.1007/s001060050569.
- 54 Karlberg M, Magnusson M, Malmstrom EM. et al. Postural and symptomatic improvement after physiotherapy in patients with dizziness of suspected cervical origin. Arch Phys Med Rehabil 1996; 77: 874-882 DOI: 10.1016/s0003-9993(96)90273-7.
- 55 Khademolhosseini Y, Pirouzi S, Ghanbari A. et al. Head and neck extension more than 30 degrees may disturb standing balance in healthy older adults. Geriatr Nurs 2020; 41: 490-495 DOI: 10.1016/j.gerinurse.2020.02.002.
- 56 Biguer B, Donaldson IM, Hein A. et al. Neck muscle vibration modifies the representation of visual motion and direction in man. Brain 1988; 111: 1405-1424 DOI: 10.1093/brain/111.6.1405.
- 57 Bove M, Courtine G, Schieppati M. Neck muscle vibration and spatial orientation during stepping in place in humans. J Neurophysiol 2002; 88: 2232-2241 DOI: 10.1152/jn.00198.2002.
- 58 Bove M, Diverio M, Pozzo T. et al. Neck muscle vibration disrupts steering of locomotion. J Appl Physiol (1985) 2001; 91: 581-588 DOI: 10.1152/jappl.2001.91.2.581.
- 59 Karnath HO, Reich E, Rorden C. et al. The perception of body orientation after neck-proprioceptive stimulation. Effects of time and of visual cueing. Exp Brain Res 2002; 143: 350-358 DOI: 10.1007/s00221-001-0996-2.
- 60 Schmid M, Schieppati M. Neck muscle fatigue and spatial orientation during stepping in place in humans. J Appl Physiol (1985) 2005; 99: 141-153 DOI: 10.1152/japplphysiol.00494.2004.
- 61 Gosselin G, Fagan MJ. The effects of cervical muscle fatigue on balance – a study with elite amateur rugby league players. J Sports Sci Med 2014; 13: 329-337
- 62 Abdelkader NA, Mahmoud AY, Fayaz NA. et al. Decreased neck proprioception and postural stability after induced cervical flexor muscles fatigue. J Musculoskelet Neuronal Interact 2020; 20: 421-428
- 63 Schieppati M, Nardone A, Schmid M. Neck muscle fatigue affects postural control in man. Neuroscience 2003; 121: 277-285 DOI: 10.1016/s0306-4522(03)00439-1.
- 64 Kruse A. Differenzierung BPLS-zervikogener Schwindel im Dix Hallpike-Test. Saarbrücken: AV Akademikerverlag; 2017
- 65 Humphriss RL, Baguley DM, Sparkes V. et al. Contraindications to the Dix-Hallpike manoeuvre: a multidisciplinary review. Int J Audiol 2003; 42: 166-173 DOI: 10.3109/14992020309090426.
- 66 Kurre A, van Gool CJAW, Bastiaenen CHG. et al. Translation, cross-cultural adaptation and reliability of the german version of the dizziness handicap inventory. Otol Neurotol 2009; 30: 359-367 DOI: 10.1097/MAO.0b013e3181977e09.
- 67 Reid SA, Callister R, Katekar MG. et al. Utility of a brief assessment tool developed from the Dizziness Handicap Inventory to screen for Cervicogenic dizziness: A case control study. Musculoskelet Sci Pract 2017; 30: 42-48 DOI: 10.1016/j.msksp.2017.03.008.
- 68 Whitney SL, Marchetti GF, Morris LO. Usefulness of the dizziness handicap inventory in the screening for benign paroxysmal positional vertigo. Otol Neurotol 2005; 26: 1027-1033 DOI: 10.1097/01.mao.0000185066.04834.4e.