Special diagnostics of certain vertigo diseases

Benign paroxysmal positional vertigo (BPLS) is detected by a special positioning maneuver. If the result is positive, this can cause positional vertigo and a so-called positional nystagmus (eye tremor) on the affected side. The patient turns his head 45° to the side while sitting and is positioned on the opposite side.

The same movement is then made in the opposite direction.If a central cause in the brain is suspected, a Doppler sonography of the vessels and a high-resolution MRI are also performed. In the diagnosis of vestibular neuritis, the neurological examination reveals a spontaneous eye tremor (spontaneous nystagmus) to the affected side. The symptoms are examined with so-called Frenzel glasses, which have a high refractive power and prevent the fixation of an object.

A tendency to fall to the diseased side is observed during various stance and gait tests. If the examiner turns the patient’s head jerkily to the affected side with both hands, an adjustment cascade can be detected. A saccade is the rapid, jerky return movement of the eyeball after an object has been fixed.

This adjustment saccade is a sign of a slowed reflex. If this so-called head impulse test does not provide a clear result, further diagnostics are followed by an electronystagmography with rinsing of the external auditory canal with cold and warm water. The diagnosis of vestibularisparoxysm can be made primarily by a suitable anamnesis.

Affected persons report short attacks of vertigo lasting a few seconds to minutes, which can manifest itself both as rotational vertigo and as vestibular vertigo. In some cases, additional symptoms are present in the ears, such as hearing loss or ringing in the ears. Such vertigo attacks can be provoked experimentally during the examination by hyperventilating or moving the head into different positions.

If the patient’s medical history and the findings of the examination lead to a well-founded suspicion of vestibular paroxysm, an MRI examination is ordered to see whether a particular vessel damages the vestibular nerves by exerting pressure. However, the MRI image can only show whether there is vascular-nerve contact; this can also be the case in healthy persons. The correct diagnosis is usually only made when the symptoms described improve after the start of therapy.

The medical history and the constellation of symptoms described by the patient also play an important role in the diagnosis of Meniere’s disease. The following symptoms are typical for this dizziness syndrome: In order to provide the physician with the most accurate information about the symptoms, it makes sense to write a seizure diary. In order to be able to make a diagnosis, at least two attacks of vertigo must have occurred and have lasted at least 20 minutes.

In addition, there must be tinnitus or a feeling of pressure on the ear, as well as a measured hearing loss. This hearing loss is determined during an audiometric examination, which is a sound sensation disorder that mainly affects the low tones.

Hearing loss
Swindle
Tinnitus

A somatoform dizziness is defined by the fact that no physical cause can be identified and the symptoms have a psychosomatic cause.

The most common form of somatoform vertigo is phobic vertigo. A physical cause can then be ruled out in the course of diagnostics. The medical history depends on the following leading symptoms: If all these symptoms are present, the diagnosis of phobic vertigo is likely.

Schwank vertigo with stance and gait insecurity
Fear of falling without actual fall
Association with typical situations (crossing bridges, crowds of people), which are avoided over time
Improvement through alcohol consumption and physical exertion