Seltenere, aber klinisch relevante episodische Schwindelsyndrome

Zusammenfassung

Die Differentialdiagnostik der selteneren, episodischen Schwindelsyndrome kann im klinischen Alltag eine Herausforderung darstellen, insbesondere wenn sie keine im Intervall messbaren Befunde in der neuro-ophthalmologischen oder -otologischen Routinediagnostik hinterlassen. Ursächlich für diese episodischen Schwindelsyndrome können physiologische Reaktionen aufgrund intersensorischer Inkongruenzen oder angeborene bzw. erworbene neuroanatomische/neurophysiologische Varianten sein, die zu vestibulären Reizsyndromen führen. In dieser Übersicht fokussieren wir auf die folgenden, aus unserer Sicht wichtigen vestibulären Syndrome: Bewegungskrankheit, Mal de Debarquement Syndrom, Visuelle Höhenintoleranz, Vestibularisparoxysmie, Zervikaler Schwindel, Episodische Ataxie Typ II und Syndrome eines dritten mobilen Fensters wie das Syndrom der Dehiszenz des superioren Bogengangs. Die Ausprägung reicht von milden Symptomen mit geringer Belastung bis hin zu schweren Krankheitsbildern mit relevanter Alltagseinschränkung. Sie können vom Kindes- oder Jugendalter bis ins Senium auftreten, teilweise mit abweichender Symptomatik. Durch gezielte Anamnese und ggf. erweiterte vestibuläre Diagnostik in einem spezialisierten Zentrum lassen sich diese Syndrome oft klar herausarbeiten und einer erfolgreichen Therapie zuführen.

Abstract

The differential diagnosis of rare episodic vertigo syndromes can be a challenge in everyday clinical practice, especially if in the attack-free interval there are no or only a few specific neuro-ophthalmological or neuro-otological findings in routine laboratory and clinical examinations. These episodic vertigo syndromes may be caused by physiological reactions due to intersensory incongruences and congenital or acquired neuroanatomical/neurophysiological variants that may lead to vestibular excitation syndromes. In this overview, we focus on the following vestibular syndromes that are - in our opinion - clinically relevant: motion sickness, mal de debarquement syndrome, visual height intolerance, vestibular paroxysmia, cervical dizziness, episodic ataxia type II, and syndromes of a third mobile window such as superior canal dehiscence syndrome. The manifestation of vestibular excitation syndromes may range from mild physiological reactions to severe clinical pictures with significant limitations in daily life. They can manifest from childhood or adolescence through to old age, sometimes with variant symptomatology. With a targeted medical history taking and, if necessary, extended vestibular diagnostics in a specialized center, these syndromes can often be clearly identified and successfully treated.

Schlüsselwörter

episodischer Schwindel - vestibuläre Reizsyndrome - Schwindelattacken - Diagnostik - Therapie

Key words

episodic vertigo - vestibular irritation syndromes - vestibular attacks - diagnostics - therapy

Publication History

Received: 30 November 2020

Accepted: 07 January 2021

Article published online:
02 March 2021

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