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Related Experiment Video

Updated: May 8, 2026

Using Unidirectional Rotations to Improve Vestibular System Asymmetry in Patients with Vestibular Dysfunction
05:02

Using Unidirectional Rotations to Improve Vestibular System Asymmetry in Patients with Vestibular Dysfunction

Published on: August 30, 2019

[Cardinal symptom vertigo from the neurologist's perspective].

M Strupp1, C Muth, N Böttcher

  • 1Neurologische Klinik und Deutsches Schwindelzentrum, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland. Michael.Strupp@med.uni-muenchen.de

HNO
|August 28, 2013
PubMed
Summary
This summary is machine-generated.

Differentiating central and peripheral vertigo is crucial for diagnosis. A systematic history and a five-step physical exam, including ocular tilt reaction and head impulse testing, effectively distinguish vertigo causes.

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Area of Science:

  • Neurology
  • Ophthalmology
  • Otolaryngology

Context:

  • Vertigo diagnosis requires distinguishing between central and peripheral causes.
  • Patient history and physical examination are key to differentiating vertigo types.
  • Acute vertigo management benefits from a structured diagnostic approach.

Purpose:

  • To outline a systematic approach for differentiating central from peripheral vertigo.
  • To detail a five-step bedside examination procedure for acute vertigo.
  • To review recent pharmacotherapy advancements for vertigo disorders.

Summary:

  • A systematic patient history and a five-step physical examination, including cover test, nystagmus analysis with Frenzel goggles, smooth pursuit, gaze-holding, and head impulse test (HIT), are effective in differentiating central and peripheral vertigo in over 90% of cases.
  • The five-step procedure aids in identifying central signs like skew deviation and central fixation nystagmus, and assesses vestibulo-ocular reflex (VOR) deficits.
  • Recent pharmacotherapy advances include cortisone for vestibular neuritis, high-dose betahistine for Menière's disease, carbamazepine for vestibular paroxysmia, and aminopyridine for specific nystagmus types and episodic ataxia.

Impact:

  • Provides a practical, evidence-based framework for neurologists to diagnose vertigo efficiently.
  • Highlights the importance of bedside clinical examination in vertigo assessment.
  • Informs clinicians about updated pharmacotherapeutic options for various vertigo conditions.