title: [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: Neurologische Klinik und Deutsches Schwindelzentrum, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland. Michael.Strupp@med.uni-muenchen.de
authors: M
authors: M
authors: Strupp
authors: C
authors: C
authors: Muth
authors: N
authors: N
authors: Böttcher
authors: O
authors: O
authors: Bayer
authors: J
authors: J
authors: Teufel
authors: K
authors: K
authors: Feil
authors: T
authors: T
authors: Bremova
authors: O
authors: O
authors: Kremmyda
authors: C S
authors: CS
authors: Fischer
mesh_terms: D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003943:Diagnostic Techniques, Neurological; D006801:Humans; D008487:Medical History Taking / Q000379:methods*; D014717:Vertigo / Q000175:diagnosis* / Q000209:etiology; D014724:Vestibular Function Tests / Q000379:methods*; D014786:Vision Disorders / Q000150:complications / Q000175:diagnosis*; D014787:Vision Tests / Q000379:methods*
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