title: [Diagnosis and treatment options in vertigo syndromes].
abstract: The key to diagnosing vertigo and balance disorders is systematic analysis of case history with clinical examination of the vestibular, oculomotor, and cerebral systems in particular. Important criteria for differentiating between the various vertigo syndromes are 1) the time course of symptoms, 2) the type of symptoms, 3) modulating factors, and 4) associated symptoms. For clinical examination of the vestibular system, six important tests are available: assessment of spontaneous nystagmus, head impulse test, dynamic visual acuity, subjective visual verticality, positioning manoeuvre, and the Romberg test/gait analysis with eyes open and closed. On the basis of five clinical signs (vertical divergence, central fixation nystagmus, gaze-evoked nystagmus, saccades, normal head impulse test), the clinical examination is able to differentiate between acute central and peripheral vestibular syndromes with a sensitivity and specificity of over 90%. The most relevant laboratory examinations are caloric irrigation and the video head-impulse test for canal function and the vestibular evoked myogenic potentials for otolith function. Finally, treatment is based upon four therapeutic principles: physiotherapy, pharmacotherapy, psychotherapy, and in rare cases, surgery.
authors.affiliation: Neurologische Klinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland. Michael.Strupp@med.uni-muenchen.de.|Deutsches Schwindel- und Gleichgewichtszentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland. Michael.Strupp@med.uni-muenchen.de.
authors.forename: M
authors.initials: M
authors.lastname: Strupp
authors.affiliation: Neurologische Klinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.|Deutsches Schwindel- und Gleichgewichtszentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland.|SyNergy, Munich Cluster for Systems Neurology, München, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Dieterich
authors.affiliation: Neurologische Klinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.|Deutsches Schwindel- und Gleichgewichtszentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Zwergal
authors.affiliation: Deutsches Schwindel- und Gleichgewichtszentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland.|Institut für Klinische Neurowissenschaften, Klinikum der Universität München, Campus Großhadern, München, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Brandt
mesh_terms: D000066491:Clinical Decision-Making / Q000379:methods; D003937:Diagnosis, Differential; D003943:Diagnostic Techniques, Neurological; D006801:Humans; D008487:Medical History Taking / Q000379:methods*; D014717:Vertigo / Q000175:diagnosis* / Q000628:therapy*; D015837:Vestibular Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D014724:Vestibular Function Tests / Q000379:methods*
keywords: Head impulse test; Saccadic smooth pursuit; Skew deviation; Spontaneous nystagmus; Vestibular evoked myogenic potential