Journal of Neurology

, Volume 261, Issue 1, pp 229–231 | Cite as

Five keys for diagnosing most vertigo, dizziness, and imbalance syndromes: an expert opinion

  • Thomas BrandtEmail author
  • Michael Strupp
  • Marianne Dieterich
Letter to the Editors

Dear Sirs,

The International Bárány Society for Neuro-Otology recently published a consensus document on how to classify vestibular disorders: vertigo is the sensation of self-motion when no self-motion is occurring; dizziness is the sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion; and imbalance or unsteadiness is the feeling of being unstable while seated, standing, or walking without a particular directional preference [ 1]. A diagnosis of vertigo, dizziness, and imbalance syndromes requires first of all a careful patient history. On the basis of our experience in the German Center for Vertigo and Balance Disorders, we find that five different categories with the following key symptoms provide a reliable and practical diagnostic guide for the general neurologist and others who manage dizzy patients:

Paroxysmal positional vertigo

(benign paroxysmal positional vertigo > central positional vertigo and/or nystagmus)




Posterior Inferior Cerebellar Artery Benign Paroxysmal Positional Vertigo Normal Pressure Hydrocephalus Vestibular Neuritis Vestibular Migraine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Judy Benson for copy-editing the manuscript. The work was supported by the German Ministry of Education and Research and the Hertie Foundation.

Conflicts of interest

The three authors declare no conflict of interest.


  1. 1.
    Bisdorff A, von Brevern M, Lempert T, Newmann-Toker DE (2009) Classification of vestibular symptoms: towards an international classification of vestibular disorders. First consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res 19:1–13PubMedGoogle Scholar
  2. 2.
    Brandt T, Dieterich M, Strupp M (2013) Vertigo and dizziness—common complaints, 2nd edn. Springer, LondonCrossRefGoogle Scholar
  3. 3.
    von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D (2013) Benign paroxysmal positional vertigo: diagnostic criteria. Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res (in press)Google Scholar
  4. 4.
    Büttner U, Helmchen C, Brandt T (1999) Diagnostic criteria for central versus peripheral positioning nystagmus and vertigo: a review. Acta Otolaryngol 119:1–5CrossRefPubMedGoogle Scholar
  5. 5.
    Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Newman-Toker D (2012) Vestibular migraine: diagnostic criteria. J Vestib Res 22:167–172PubMedGoogle Scholar
  6. 6.
    American Academy of Otolaryngology-Head and Neck Foundation (1995) Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere’s disease. Otolaryngol Head Neck Surg 113:181–185CrossRefGoogle Scholar
  7. 7.
    Cnyrim CD, Newman-Toker D, Karch C, Brandt T, Strupp M (2008) Bedside differentiation of vestibular neuritis from central “vestibular pseudoneuritis”. J Neurol Neurosurg Psychiatry 79:458–460CrossRefPubMedGoogle Scholar
  8. 8.
    Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE (2009) HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 40:3504–3510CrossRefPubMedGoogle Scholar
  9. 9.
    Kim HA, Lee H (2012) Recent advances in central acute vestibular syndrome of a vascular cause. J Neurol Sci 321:17–22CrossRefPubMedGoogle Scholar
  10. 10.
    Brandt T, Dieterich M (1994) Vestibular paroxysmia: vascular compression of the eighth nerve? Lancet 343:798–799CrossRefPubMedGoogle Scholar
  11. 11.
    Hufner K, Barresi D, Glaser M, Linn J, Adrion C, Mansmann U, Brandt T, Strupp M (2008) Vestibular paroxysmia: diagnostic features and medical treatment. Neurology 71:1006–1014CrossRefPubMedGoogle Scholar
  12. 12.
    Minor LB (2005) Clinical manifestation of superior semicircular canal dehiscence. Laryngoscope 115:1717–1727CrossRefPubMedGoogle Scholar
  13. 13.
    Chien WW, Carey JP, Minor LB (2011) Canal dehiscence. Curr Opin Neurol 24:25–31CrossRefPubMedGoogle Scholar
  14. 14.
    Brandt T (1996) Phobic postural vertigo. Neurology 46:1515–1519CrossRefPubMedGoogle Scholar
  15. 15.
    Bronstein AM (2004) Vision and vertigo: some visual aspects of vestibular disorders. J Neurol 251:381–387CrossRefPubMedGoogle Scholar
  16. 16.
    Zingler VC, Cnyrim C, Jahn K, Weintz E, Fernbacher J, Frenzel C, Brandt T, Strupp M (2007) Causative factors and epidemiology of bilateral vestibulopathy in 255 patients. Ann Neurol 61:524–532CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Thomas Brandt
    • 1
    Email author
  • Michael Strupp
    • 2
  • Marianne Dieterich
    • 2
  1. 1.Institute for Clinical Neurosciences and German Center for Vertigo and Balance DisordersLudwig-Maximilians UniversityMunichGermany
  2. 2.Department of Neurology and German Center for Vertigo and Balance DisordersLudwig-Maximilians UniversityMunichGermany

Personalised recommendations