Differenzialdiagnose „Schwindel“

Zusammenfassung

„Schwindel“ ist ein Symptom mit interdisziplinärer Bedeutung. Die Differenzierung und Einordnung von Schwindelsyndromen erfordert jedoch auch fachübergreifende Kenntnisse. Gerade beim subjektiven Symptom „Schwindel“ ist eine subtile Analyse der zugrunde liegenden Beschwerden erforderlich. Internationale Krankheitsdefinitionen sind bei der Differenzialdiagnose von Schwindelsyndromen heute ein unverzichtbares Hilfsmittel. Mit einfachen Mitteln können heute Augenbewegungsstörungen und Nystagmus untersucht und fachspezifisch zugeordnet werden. Screeninguntersuchungen (z.B. Kopfimpulstest) sind heute ein obligates Instrument bei der Untersuchung von Patienten mit Schwindelsyndromen als Notfall. Mit objektiven diagnostischen Verfahren (kalorische Nystagmografie, Videokopfimpulstest, vestibulär evozierte myogene Potenziale) kann das Ausmaß einer funktionelle Beeinträchtigung der fünf vestibulären Rezeptoren heute seiten- und rezeptorspezifisch aber auch unter dynamischen Aspekten beurteilt werden.

Abstract

Vertigo and dizziness are symptoms of interdisciplinary dimension. However, the differentia­tion and classification of vertigo syndromes also require experience and multidisciplinary knowledge. Since the clinical syndrome is subjective, a detailed analysis of the complaints underlying is required. International disease definitions are an indispensable tool in the differential diagnosis of vertigo syndromes today. With simple diagnostic tools eye movement disorders and nystagmus can be examined and assigned to specific vestibular disorders today. Screening tests (e.g. head impulse test) are now an important instrument in the investigation of patients with vertigo syndromes in case of emergency. With objective diagnostic methods (caloric irrigation, video head impulse test, vestibular evoked myogenic potentials) the degree of functional impairment of the five vestibular receptors can be assessed quantitatively. Furthermore, in vestibulopathies, a receptor and side-specific diagnostic assessment can be performed even with regard to dynamic aspects.

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