Purpose of Review: Symptoms and signs of neuro-otologic disorders are critical
components in the diagnostic assessment of patients with vestibular symptoms such
as vertigo, dizziness, unsteadiness, and oscillopsia. Most diagnoses can be accomplished
at the bedside. An understanding of key diagnostic principles is essential for
all practicing neurologists, who are often faced with determining whether such
patients warrant urgent diagnostic testing or hospital admission. This article introduces
readers to core concepts and recent advances in the understanding of directed
history taking and physical examination in patients with vestibular symptoms
or suspected neuro-otologic disorders.
Recent Findings: International consensus definitions for vestibular symptoms have
recently been published. During the past 5 years, a growing body of scientific evidence
has demonstrated that the traditional approach to bedside diagnosis of patients
with vertigo and dizziness is inadequate. Former teaching that history taking
should first rely on categorizing symptoms by type (eg, vertigo, presyncope, disequilibrium,
nonspecific dizziness) has been replaced by an emphasis on categorizing
timing and triggers for vestibular symptoms, which focuses the clinician’s
attention on four key syndromic patterns: (1) acute, spontaneous, prolonged vestibular
symptoms; (2) episodic, positional vestibular symptoms; (3) episodic, spontaneous
vestibular symptoms; and (4) chronic unsteadiness (with or without oscillopsia). Each
of these categories delineates a relatively narrow differential diagnosis within which a
focused examination distinguishes between benign common causes and dangerous
uncommon ones.
Summary: A focused approach to bedside assessment of patients with vestibular
symptoms is essential for accurate and efficient diagnosis. All neurologists should be
aware of major recent advances. |