Vertigo (Dizziness): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; further:
  • Inspection (viewing).
    • Skin, mucous membranes, and eyes [nystagmus – involuntary but rapid rhythmic eye movements; also seen in seizure in Meniere’s disease]
    • Gait pattern or examination of gait and balance: [gait ataxia (gait disorders)]
      • Freely selected walking speed
      • Walking and counting test
      • Get up and go test (“Timed Up and Go” test).
• ENT medical examination
  • Nystagmus examination:
    • Spontaneous nystagmus – indication of vestibular disorder.
    • Adjustment nystagmus in extreme gaze adjustment: if exhaustible, then physiological; otherwise, indication of vestibular disorder.
    • Gaze direction nystagmus: saccadic movement, indication of cerebellar disorder.
  • Rapid head rotation test/head impulse test (horizontal) as a trigger for vertigo/nystagmus: neuritis vestibularis and vestibulopathies [with a suspected diagnosis of “neuritis vestibularis”” an unremarkable test may be an indication of a (rare) cerebellar infarction].
  • Rapid head rotation test/head impulse test (horizontal) as a trigger for vertigo/nystagmus followed by nystagmus suppression by head nodding (head shake and tilt test):
    • Failure to suppress nystagmus by head nodding → central cause of vertigo (very likely).
  • Positional test according to Dix-Hallpike in positional vertigo (BPPV).
• Neurological examination
  • Refex status
  • Sensitivity on legs (+ tuning fork).
  • Finger–nose and knee-hook test (cerebral/brain related, cerebellar/cerebellum).
  • Retention test (exclusion of latent paresis).
  • Romberg standing test (synonyms: Romberg test; Romberg test) (cerebellar, spinal, vestibular) – The Romberg standing test is used as a clinical test to investigate ataxia (vestibular, spinal (spinal cord), or cerebellar (cerebellum)) and can help differentiate between spinal and cerebellar ataxia. To perform it, the patient is asked to stand with feet close together and arms outstretched and eyelids closed. A positive finding (= positive Romberg sign) denotes a deterioration in coordination due to closure of the eyelids. A sign of deterioration is an increasing swaying, which would be indicative of spinal ataxia. A negative finding indicates unchanged coordination after eye closure.
    • If the patient can control sway only incompletely or not at all, even with eyes open, this is indicative of cerebellar ataxia.
    • A tendency to fall in one direction after eye closure would speak for damage to the respective vestibular organ.
  • Diadochokinesis (cerebellar).
• Orthopedic examination [due todifferential diagnosis: functional disorders of the cervical spine].
• Psychiatric examination [due todifferential diagnoses:
  • Agoraphobia – fear of wide places.
  • Alcohol abuse (heavy drinking)
  • Depression
  • Drug use]
• Health check

Diseases and their typical forms of vertigo

Square brackets [ ] indicate possible pathological (pathological) physical findings.