Zusammenfassung
Zentralvestibuläre Schwindelformen können einerseits als klar definiertes Leitsymptom mit typischem Okulomotorikbefund vorkommen (z. B. Downbeat- oder Upbeat-Nystagmus), der sich nur bei zentralen infratentoriellen Läsionen findet und eine topische Zuordnung erlaubt, oder als Teil eines komplexen neurologischen Syndroms mit Okulomotorikstörungen und weiteren begleitenden neurologischen Defiziten des Hirnstamms (z. B. Ocular tilt reaction beim Wallenberg-Syndrom mit Horner-Syndrom, Sensibilitätsstörungen, Ataxie, Gaumensegelparese, Dysarthrie und Dysphagie). Aus den Begleitsymptomen (Paresen, Schluck-, Sprech-, Sensibilitätsstörungen) und dem klinischen Untersuchungsbefund lässt sich in der Regel der Ort der Schädigung festlegen. Aber auch bei fehlenden weiteren neurologischen Defiziten erlauben das okulomotorische Syndrom, die Wahrnehmungs- und Haltungsregulationsstörung oft eine topische Hirnstammdiagnostik, da für bestimmte vestibuläre Syndrome - eingeteilt nach den drei Hauptarbeitsebenen des vestibulookulären Reflexes - bislang bestimmte, voneinander abzugrenzende Läsionsorte beschrieben wurden. Diese werden hier dargestellt.
Abstract
A clinical classification of central vestibular syndromes is presented according to the three major planes of action of the vestibulo-ocular reflex (VOR), yaw, pitch, and roll, which allows for a precise topographic diagnosis of brainstem lesions as to their level and site. The plane-specific vestibular syndromes are determined by ocular motor, perceptual, and postural signs. A tone imbalance in roll indicates unilateral lesions, ipsiversive at pontomedulary level, contraversive at pontomesencephalic level. A tone imbalance in pitch indicates bilateral paramedian lesions of the medullary or ponto-mesencephalic brainstem or bilateral dysfunction of the flocculus. Pure syndromes in yaw are rare, since the small causative area covering the medial and superior vestibular nucleus is not only adjacent to but overlapped by the structures also subserving roll function.
Key words
Vestibulo - ocular reflex - vestibular system - nystagmus - brainstem topography
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Prof. Dr. med. Marianne Dieterich
Neurologische Klinik · Johannes Gutenberg-Universität Mainz
Langenbeckstraße 1
55131 Mainz
