International Classification of Vestibular Diseases (ICVD) [1; adapted from 2].
| Level 1Symptoms and clinical signs | Vertigo diffuse unsteadiness oscillopsia vertigo nystagmus OTR VOR failure ……. | ||
| Level 2Syndromes | Acute vestibular syndrome | episodic vestibular syndrome | chronic vestibular syndrome |
| Level 3Diseases | Disorders primarily classified as vestibular disease | ||
| Vestibular symptoms of disorders classified elsewhere | |||
| Level 4Disease mechanisms | genetic……. | inflammatory……. | traumatic……. |
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- OTR: “ocular tilt reaction” (vertical divergence of the eyes).
- VOR: vestibuloocular reflex: when the head turns, the eyes are moved at the same speed in the opposite direction, so that an object can continue to be fixated. This brainstem reflex thus allows stable visual perception even in the event of sudden head movement.
The classification presented above is based on the recommendation to attach less importance to symptom quality. For diagnosis, the method TITRATE – “timing, triggers and targeted examination” – is recommended here: timing (temporal course), triggers (triggers), targeted examination (targeted examination). Acute vestibular syndrome: acute onset, persistent, severe spinning or diffuse vertigo and/or imbalance lasting at least one day. Furthermore, evidence of new onset and persistent disturbances of the vestibular system (e.g., nystagmus (rapid involuntary pupillary movements), balance disturbances, vomiting). Typical conditions include neuritis vestibularis (persistent spinning vertigo), herpes zoster oticus (variant of herpes zoster/shingles), labyrinthitis (inflammation of the inner ear), and intoxications (poisoning; e.g., carbamazepine overdose). Episodic vestibular syndrome: recurrent attacks of spinning or diffuse vertigo and/or imbalance lasting seconds, minutes, or hours with complete cessation of symptoms between attacks. Furthermore, evidence of intermittent vestibular disorders (e.g., nystagmus, nausea, falls). Typical conditions include Meniere’s disease, vestibular migraine, benign positional vertigo, vestibular paroxysmia (recurrent, short-lasting vertigo attacks), orthostatic vertigo (after standing up quickly), transient ischemic attack (TIA), panic attacks. Chronic vestibular syndrome: chronic, spinning or diffuse vertigo and/or imbalance. Furthermore, evidence of persistent vestibular disorders such as nystagmus, oscillopsia (visual disturbance in which the affected person perceives objects fixed with the eyes as trembling or swaying), gait unsteadiness. Typical diseases are unilateral or bilateral vestibular loss, defective states after apoplexy (stroke), cerebellar ataxias (cerebellar gait disorders). Note: The typical diseases mentioned are part of the topic “Disorder of vestibular function” or partly individual disease topics (e.g. Meniere’s disease). Vestibular symptoms: A distinction is made between 4 symptoms:
- Vertigo as an illusion of a movement1 that does not really occur, or as a real movement that is experienced distorted.
- Diffuse vertigo (“dizziness”)1: sensation of disturbed spatial perception, but without illusion of motion.
- Visuovestibular symptoms include: Oscillopsia (visual disturbance in which the affected person perceives objects fixed with the eyes as trembling or swaying); blurred vision during head movements; external vertigo as an illusion that the environment is rotating.
- Postural symptoms2: sensation of imbalance, directional (e.g., lateropulsion/tendency to sink or fall sideways to the left) or nondirectional, and near falls and tumbles caused by disturbances in balance.
1Dizziness is further subdivided into “spontaneously occurring” or “triggered” by head movement, positioning, orthostasis (upright posture), visual stimuli, Valsalva phenomenon (dizziness following forced breathing), sounds, or other triggers.2Postural control refers to the ability of the human body to maintain an upright body position under the influence of gravity.