Internal Medicine

Diagnosis of dizziness

The diagnosis of vertigo is based on a detailed medical history and a thorough physical examination. Most vertigo syndromes can be diagnosed and distinguished from one another in this way.

Diagnosis from the family doctor

Which examinations are carried out by the family doctor?

The standard examination includes checking the so-called vital parameters (Blood pressure, pulse, breathing).
With this, the doctor wants to check whether the cause of the vertigo is a disorder of the Cardiovascular system is due. This includes measuring blood pressure, heart rate and breathing rate.

In order to rule out a cardiac arrhythmia, heart valve defect or outflow disorder of the heart, the heart bugged (Auscultation) and a electrocardiogram (EKG) prepared. The neck arteries (Aa. carotides) are monitored for flow noises.If such flow noises are detected, this indicates a narrowing of the arteries (Stenosis).
The lung is knocked off (percussion) and bugged (Auscultation) to a lung infection exclude, which could lead to an oxygen deficiency in the entire circuit.

The doctor will put a small lamp in your eyes to test the pupillary response. He also tests the jerky adjustment movements of the eyes when looking to the right and left (Nystagmus).
Unequal adjustment movements would be due to a centrally-conditioned (brain) or systemic vertigo emanating from the balance organ.

Using a brief neurological examination, the doctor checks reflexes with the reflex hammer, sensitivity of the skin, feeling of pressure and joint perception when the eyes are closed in order to obtain an indication of the surface and depth perception of the patient. A disruption of these perceptions could be a disruption of the Equilibrium or encourage dizziness.

Diagnosis from a specialist

What will be examined if the family doctor refers me to a specialist?

Because dizziness can originate in many different specialties, many different disciplines can investigate.
In Vertigo clinics, which some practices and clinics offer, comprehensive diagnostics is offered in cooperation with all disciplines.

Investigations are carried out in the following departments:

ENT examination (Ear, nose and throat medicine)
Ophthalmological examination (Ophthalmology)
Orthopedic examination (Orthopedics)
Neurological examination (Neurology)

Ear, nose and throat medicine

A ENT doctor (ENT doctor) is a suspected disturbance in the area of the equilibrium organ Rinsing the ear canals with cold and warm water carry out (Caloric test). This will be provokes neurological reactions, for example nystagmus, which suggest a cause of the dizziness. A Storage test can via freely moving particles in the semicircular canal system of the equilibrium organ (Canalolithiasis) Provide information.

Ophthalmology

Of the Ophthalmologist checks general eyesight, a restriction of the field of vision and measures the Intraocular pressure. Limitations of these qualities provoke a feeling of insecurity when running with dizziness, especially in older people.

Orthopedics

The orthopedist (Specialist in Orthopaedics) will be the Spine, specifically the Cervical spine take a closer look and examine for postural damage, muscle profile, blockages and tension.

neurology

A neurologist will pay particular attention to symptoms that Signs of a brain stem or cerebellar injury represent. Sensory disturbances in the oral mucosa, palatine paralysis, swallowing disorders, eye movement disorders or hemiplegia give indications of a central cause of dizziness.

If an injury, bleeding, skull base fracture, or tumor is suspected, the neurologist will call in Computed tomography (CT) or one Magnetic resonance imaging (MRI) of the skull request to get an exact overview of the inside of the skull.

Special diagnosis of certain vertigo diseases

Diagnosis of benign paroxysmal positional vertigo

The benign paroxysmal positional vertigo (BPLS) is proven by means of a special positioning maneuver. If the result is positive, positional vertigo and so-called positional nystagmus (Eye tremors) on the affected side. While sitting, the patient turns his head 45 ° to the side and is positioned on the opposite side. Then the same movement takes place in the other direction.

If there is a suspicion of a central cause in the brain, a Doppler sonography of the vessels and a high-resolution MRI are also performed.

Diagnostics of vestibular neuritis

When diagnosing the Vestibular neuritis falls at the neurological examination a spontaneous eye tremor (Spontaneous nystagmus) to the affected side. The symptoms are examined using so-called Frenzel glasses, which have a high lens refractive power and prevent fixation of an object.
A Tendency to fall to the sick side is observed in various stance and gait tests. If the examiner jerks the patient's head to the affected side with both hands, a Setting saccade turn off. A saccade is the rapid, jerky return movement of the eyeball after an object has been fixed. This setting saccade is considered a sign of a slowed reflex. If this so-called Head impulse test does not provide a clear result, one follows in the further diagnosis Electronystagmography with rinsing of the external auditory canal with cold and warm water.

Diagnostics of vestibular paroxysmia

The diagnosis of Vestibular paroxysmia can primarily through a appropriate medical history be asked. Those affected report short periods lasting a few seconds to minutes Dizziness, which are both Vertigo or as Vertigo can express. In some cases there are also symptoms of the ears, such as one Hearing loss or a ringing in the ear. Such attacks of vertigo can be provoked experimentally during the examination by hyperventilating or moving the head in different positions. If, based on the medical history and the examination findings, there is a justified suspicion of vestibular paroxysmia, an MRI examination is arranged to see whether a certain vessel is the Balance nerves damaged by pressure. In the MRI image, however, it can only be seen whether there is vascular-nerve contact; this can also be the case in healthy people. The correct diagnosis is usually only made when the symptoms described improve after starting therapy.

Diagnostics of Meniere's disease

Also in the diagnosis of the Meniere's disease The anamnesis and the constellation of symptoms described by the patient play an important role. The following symptoms are typical for this vertigo syndrome:

Hearing loss
dizziness
Tinnitus

In order to provide the doctor with the most precise information possible about the symptoms, it makes sense to write a seizure diary. In order to be able to make the diagnosis, at least two vertigo attacks must have occurred that have lasted at least 20 minutes. In addition, a Tinnitus or a feeling of pressure on the ear, as well as a measured hearing loss. This hearing loss is determined in the course of an audiometric examination, this is a Sensory sensation disorderwhich mainly affects the low notes.

Diagnosis of somatoform postural vertigo

Somatoform vertigo is defined by the fact that no physical cause can be determined and the symptoms have a psychosomatic cause. The most common form of somatoform dizziness is phobic postural vertigo. A physical cause can then be excluded as part of the diagnosis. The anamnesis is based on the following key symptoms:

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

If all these symptoms are present, the diagnosis is phobic vertigo probably.

Dizziness and headache

The two symptoms dizziness and headache can often occur together, which can have different causes.

If symptoms of dizziness suddenly appear in combination with severe headaches, a cerebral haemorrhage should urgently be ruled out. This is especially true if the two symptoms have never occurred at the same time before. The diagnosis is then made with the aid of computed tomography and / or CT angiography.

Headache, which is often pronounced at the back of the head, is also a typical symptom of vestibular migraines. The so-called vertigo migraine occurs repeatedly and disappears after a few hours. It is accompanied in varying degrees by nausea, unsteadiness and unsteadiness, impaired vision and sensitivity to light. About a third of the time, it occurs without a headache.

You might also be interested in this article: Dizziness and migraines - what is the underlying disease?

Guidelines for the diagnosis of vertigo

The German guidelines for vertigo diagnostics emphasize the importance of a careful physical examination and a detailed medical history. Imaging methods such as CT or MRT and other technical equipment are generally not used, but only in the case of certain suspicious factors. Regardless of the dizziness present, similar diagnostic criteria are always used. They help in the differentiation of the individual vertigo syndromes. These criteria include the type of vertigo (Spinning, swaying, dizziness), the temporal expansion (Attack or constant vertigo), any accompanying symptoms (Nausea, headache etc.) and the movement-dependent or movement-independent occurrence of vertigo.

Also read the article: Vertigo without findings.