Moderne Schwindeldiagnostik

Abstract

Modern diagnostic methods such as video head impulse test and cervical and ocular vestibular evoked myogenic potentials allow to measure canal and otolith function quantitatively and objectively. These methods contribute to a complex assessment of the functional integrity of all 5 sensory elements of the vestibular organ for the first time. Moreover, in combination with additional vestibular tests frequency specific and time depended changes of impairments of vestibular sensors and their pathways can be assessed. Over the past few years, new test methods have been established step by step in daily clinical diagnostic of vertigo and dizziness in acute vestibular syndrome and chronic complaints. Modern tests and concepts caused a paradigm shift in vestibular diagnostic. New classifications of vestibular disorders and algorithms provide a high diagnostic certainity and reliability although evidence-based investigations of diagnostic procedures are still missing.

Seltene Erkrankungen des vestibulären Labyrinths: von Zebras, Chamäleons und Wölfen im Schafspelz

“…Weiterhin haben sich die diagnostischen Optionen bei Erkrankungen des Labyrinths in den letzten 20 Jahren deutlich verbessert. So stehen heute mit dem Video-Kopf-Impuls-Test ( video head impulse test, vHIT) 7 und den vestibulär evozierten myogenen Potenzialen (VEMPs) 8 9 10 11 12 Methoden für eine spezifische, seitengetrennte, reproduzierbare, quantifizierbare und zeitsparende Diagnostik aller 5 vestibulären Rezeptororgane und ihrer Afferenzen zur Verfügung («Fünf-Rezeptor-Diagnostik») 13 14 15 . Während die okulären VEMPs (oVEMPs) überwiegend ein Mass für die kontralaterale Utrikulusfunktion darstellen, sind die cervicalen VEMPs (cVEMPs) überwiegend ein Indikator für die ipsilaterale Sakkulusfunktion 16 .…”

“…Furthermore, laboratory testing for vestibular disorders has made a huge progress within in the past 20 years. Today, video head impulse test (vHIT) 7 and vestibular evoked myogenic potentials (VEMPs) 8 9 10 11 12 allow fast, innocuous, reproducible and specific assessment of all five vestibular receptor organs of one labyrinth and their afferents 13 14 15 . While ocular VEMPs (oVEMPs) mainly assess contralateral utricular function, cervical VEMPs (cVEMPs) are predominantly an indicator of ipsilateral saccular integrity 16 .…”

Current diagnostic procedures for diagnosing vertigo and dizziness

“…Causes concerning internal medicine (e.g. orthostatic hypotension, syncopes, cardiac arrhythmia) where vestibular reflexes are not causally involved are not included in the term of vestibular vertigo [ 66 ]. Rarer origins in the ophthalmological sector (e.g.…”

“…Vertigo syndromes with symptom-free intervals are called episodic (paroxysmal) vertigo. They can be differentiated against permanent complaints (permanent vertigo) [ 66 ], [ 71 ].…”

“…For the physician, the ambiguous and unspecific symptoms are often difficult to interpret. For retrieving anamnestic information in cases of vertigo, an analytic procedure with the following basic elements in the described sequence has turned out to be useful [ 66 ], [ 71 ], [ 94 ].…”