Referral and Final Diagnoses of Patients Assessed in an Academic Vertigo Center

Abstract

Objective: To identify under-diagnosed neuro-otological disorders and to evaluate whether under-diagnosing depends on the age of the patient. Materials and methods: Retrospective analysis of medical charts from 951 consecutive patients (685 under and 266 above the age of 65 years) who entered diagnostic procedures at the Interdisciplinary Center for Vertigo and Balance Disorders, University Hospital Zurich, Switzerland. Final diagnoses were compared to referral diagnoses. Results: Relative to referral diagnoses, the proportion of patients finally diagnosed with benign paroxysmal positional vertigo (BPPV) almost doubled both in younger (<65 year from 12.7 to 25.1%) and older patients (from 20.7 to 37.6%). Striking relative increases were found for the diagnoses multisensory dizziness in older patients (from 20.7 to 37.6%) and vestibular migraine in younger patients (1.8 to 20.2%). In both age groups, the proportion of patients with undetermined diagnoses was reduced by about 60% (younger: 69.8 to 9.8%; older: 69.2 to 12.4%) by the diagnostic procedures in the vertigo center. These changes were all significant (p < 0.05) in McNemar tests with continuity correction (2 × 2 tables: focused diagnosis vs. other diagnoses, referral vs. final). Conclusion: Significant changes of diagnoses can be expected by a specialized neuro-otological work-up. In particular, BPPV, multisensory dizziness, and vestibular migraine are under-diagnosed by referring physicians. This finding calls for better education of primary care takers in the field of neuro-otology.

Vestibular migraine: diagnosis challenges and need for targeted treatment

“…In a study conducted by a specialized clinic in Switzerland, dizziness was diagnosed as vestibular migraine in 20.2% of patients, although VM was previously suspected by the requesting physicians in only 1.8%. The diagnosis of "uncertain dizziness" accounted for almost 60% of patients 11 . In another study in Germany, with 33 patients, two-thirds of patients diagnosed with VM had consulted a doctor because of vertigo, but only 20% were diagnosed with VM.…”

Acil Serviste Vertigoya Yaklaşım

“…Bening paroksismal pozisyonel vertigo (BPPV), periferal vestibüler bozuklukların en sık nedenidir ve yıllık prevalansı yaşam boyu genel nüfusun % 2' sidir 23,24 . Özelleşmiş vertigo kliniklerine sevkedilmiş hastaların yaklaşık % 20'sinde BPPV saptanmıştır 25,26 . Vestibüler bozukluklar arasında daha az sıklıkla görülen meniere hastalığının 100.000 de 3.5 ile 513 arasında değişen bir prevalansı varken, vestibüler nöritin yıllık insidansı 100.000 de 3.5 olarak rapor edilmiştir 6 .…”

Diagnosis, treatment, and rehabilitation in patients with dizziness and cognitive impairment

“…Следует отметить, что в нашей стране часто ошибочно диагностируются вертебро-базилярная недостаточность, а также компрессия позвоноч-ных артерий вследствие шейного остеохондроза, назнача-ются малоинформативные методы обследования, что не по-зволяет установить истинные причины головокружения и начать эффективное лечение. Это может быть обусловлено недостаточной осведомленностью врачей о наиболее час-тых причинах головокружения и неустойчивости, а также о методах диагностики основных вестибулярных заболеваний [3][4][5][6]. К высокоинформативным дополнительным методам обследования вестибулярной системы относятся видеонис-тагмография, тональная пороговая аудиометрия, электро-кохлеография и др.…”