[Cardinal symptom vertigo from the neurologist's perspective].

Abstract

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.

• Authors: M Strupp, C Muth, N Böttcher, O Bayer, J Teufel, K Feil, T Bremova, O Kremmyda, C S Fischer
• Journal: HNO (HNO) Vol. 61 Issue 9 Pg. 762-71 (Sep 2013) ISSN: 1433-0458 [Electronic] Germany
• Vernacular Title: Leitsymptom Schwindel aus Sicht des Neurologen.
• PMID: 23979117 (Publication Type: English Abstract, Journal Article)

Topics

• Brain Diseases (complications, diagnosis)
• Diagnosis, Differential
• Diagnostic Techniques, Neurological
• Humans
• Medical History Taking (methods)
• Vertigo (diagnosis, etiology)
• Vestibular Function Tests (methods)
• Vision Disorders (complications, diagnosis)
• Vision Tests (methods)