Cardinal symptom vertigo from the neurologist's perspective

• Published in: HNO 2013-09, Vol.61 (9), p.762
• Main Authors: Strupp, M, Muth, C, Böttcher, N, Bayer, O, Teufel, J, Feil, K, Bremova, T, Kremmyda, O, Fischer, C S
• Format: Article
• Language: ger
• Subjects: Brain Diseases - complications; Brain Diseases - diagnosis; Diagnosis, Differential; Diagnostic Techniques, Neurological; Humans; Medical History Taking - methods; Vertigo - diagnosis; Vertigo - etiology; Vestibular Function Tests - methods; Vision Disorders - complications; Vision Disorders - diagnosis; Vision Tests - methods
• ISSN: 1433-0458
• DOI: 10.1007/s00106-013-2746-8

In most patients with vertigo, the first and clinically most important question posed to neurologists is whether it is a central or a peripheral syndrome. In more than 90 % of cases, this differentiation is made possible by systematically recording the patient history (asking about the type of vertigo, the duration, triggers and accompanying symptoms) and conducting a physical examination. Particularly in the case of acute vertigo disorders, a five-step procedure has proven useful: 1. A cover test to look for vertical divergence (skew deviation) as a central sign and component of the ocular tilt reaction (OTR); 2. Examination with and without Frenzel goggles to differentiate between peripheral vestibular spontaneous nystagmus and central fixation nystagmus; 3. Examination of smooth pursuit; 4. Examination of the gaze-holding function (particularly gaze-evoked nystagmus beating in the opposite direction to spontaneous nystagmus); 5. The head impulse test to look for a deficit in the vestibulo-ocular reflex (VOR). Considerable advances have been made in the pharmacotherapy of vertigo disorders during the last 10 years, including cortisone for the treatment of acute vestibular neuritis, betahistine as a high-dose long-term treatment for Menière's disease, carbamazepine to treat vestibular paroxysmia and aminopyridine for down- and upbeat nystagmus and episodic ataxia type 2.