Zusammenfassung
Schwindel ist ein häufiges Notfallsymptom mit einem weiten Diagnosespektrum. Von dem meist ungefährlichen peripheren Schwindel, der seine Ursache in einer Störung des Gleichgewichtsorgans und/oder des N. vestibulocochlearis hat, ist der zentrale Schwindel zu unterscheiden. Dieser hat seine Ursache in einer Störung zentralnervöser Regionen und kann lebensbedrohliche Durchblutungsstörungen der Gehirnanteile der hinteren Schädelgrube anzeigen. Deswegen ist jeder Patient mit Schwindel systematisch zu befragen und zu untersuchen, um die risikobehaftete zentrale Genese zu erfassen. Die körperliche Untersuchung durch den erstaufnehmenden Arzt sollte den Halmagyi-Test, die Nystagmusprüfung unter der Frenzel-Brille und die Erfassung der regelrechten Bulbusstellung im Abdecktest umfassen. Liegt der Verdacht auf einen benignen paroxysmalen Lagerungsschwindel vor, schließt sich ein Lagerungstest an. Die ideale weiterführende Diagnostik bei Verdacht auf einen zentralen Schwindel besteht in einer Magnetresonanztomographie. Patienten mit zentralem Schwindel müssen stationär neurologisch behandelt werden, die risikoarmen akuten peripheren Schwindelformen können meist ambulant mit symptomatischer Therapie durch Hals-Nasen-Ohrenärzte weiterbetreut werden.
Abstract
Vertigo and dizziness are common symptoms in the acute care setting and have a wide diagnostic range. The most deleterious diagnosis is vertebrobasilar disease with brain infarction in the posterior fossa. Therefore, every patient with acute vestibular syndrome needs to be evaluated by a structured interview and a systematic physical examination for red flag symptoms which indicate vertebrobasilar infarction. Routinely, the physical examination should cover the head impulse (Halmagyi) test, test for nystagmus as well as the test of skew and in cases of benign paroxysmal positional vertigo, by the Dix-Hallpike maneuver. The suspicion of a central cause of vertigo is ideally confirmed by a magnetic resonance imaging (MRI) scan. Most patients with a peripheral cause of vertigo can be discharged under symptomatic therapy with the advice to consult an ear nose and throat physician while patients with a central cause of vertigo are admitted for further neurological treatment.
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Dodt, C., Zelihic, E. Schwindel. Med Klin Intensivmed Notfmed 108, 41–46 (2013). https://doi.org/10.1007/s00063-012-0173-3
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DOI: https://doi.org/10.1007/s00063-012-0173-3