Journal of Neurology

, Volume 262, Issue 8, pp 1977–1980 | Cite as

Functional dizziness: diagnostic keys and differential diagnosis

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

Dear Sirs,

In the 1990s, 9 % of neurological inpatients were found to have functional (then called psychogenic or somatoform) rather than structural neurological disorders of the nervous system as the primary cause of admission [1]. This is a conservative figure, since secondary and minor pseudo-neurological symptoms were not included; other studies later found up to 18–20 % [2]. In a further study, it was reported that 61 % of patients referred to a neurology service had at least one medically unexplained symptom, and 35 % fulfilled the diagnostic criteria for an ICD-10 somatoform disorder [3].

Functional dizziness is one of the most frequent functional disorders in adult in- and outpatients. In a tertiary referral dizziness unit, it accounted for 19.5 % of 17,700 adult outpatients; thus, it is the second most common diagnosis after benign paroxysmal positional vertigo [4]. The frequencies vary for different countries and study designs: 2.5 [5], 16 [6], and 23 % [7] have been...


Specific Phobia Benign Paroxysmal Positional Vertigo Vestibular Neuritis Vestibular Migraine Superior Semicircular Canal 
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 (Grant Nos. 01EO0901 and 01EO1401) and the Hertie Foundation.

Conflicts of interest

The four authors declare no conflict of interest.


  1. 1.
    Lempert T, Dieterich M, Huppert D, Brandt T (1990) Psychogenic disorders in neurology: frequency and clinical spectrum. Acta Neurol Scand 82:335–340CrossRefPubMedGoogle Scholar
  2. 2.
    Fink P, Hansen MS, Oxhoj ML (2004) The prevalence of somatoform disorders among internal medical inpatients. J Psychosom Res 56:413–418CrossRefPubMedGoogle Scholar
  3. 3.
    Fink P, Hansen MS, Sondergaard L (2005) Somatoform disorders among first-time referrals to a neurology service. Psychosomatics 46:540–548CrossRefPubMedGoogle Scholar
  4. 4.
    Brandt T, Dieterich M, Strupp M (2013) Vertigo and dizziness: common complaints, 2nd edn. Springer, LondonCrossRefGoogle Scholar
  5. 5.
    Ketola S, Niemensivu R, Henttonen A, Appelberg B, Kentala E (2009) Somatoform disorders in vertiginous children and adolescents. Int J Ped Otorhinolaryngol 73:933–936CrossRefGoogle Scholar
  6. 6.
    Lopez-Gentili LI, Kremenchutzky M, Salgado P (2003) A statistical analysis of 1300 patients with dizziness-vertigo. Its most frequent causes. Rev Neurol 36:417–429PubMedGoogle Scholar
  7. 7.
    Obermann M, Bock E, Sabev N, Lehmann N, Weber R. et al. (2015) Long-term outcome of vertigo and dizziness associated disorders following treatment in specialized tertiary care—the Dizziness and Vertigo Registry (DiVeR) study. J Neurol (in press)Google Scholar
  8. 8.
    Batu ED, Anlar B, Topcu M, Turanli G (2015) Vertigo in childhood: a retrospective series of 100 children. Eur J Paed Neurol 19:226–232CrossRefGoogle Scholar
  9. 9.
    Brandt T, Strupp M, Novozhilov S, Krafczyk S (2012) Artificial neural network posturography detects the transition of vestibular neuritis to phobic postural vertigo. J Neurol 259:182–184CrossRefPubMedGoogle Scholar
  10. 10.
    Huppert D, Kunihiro T, Brandt T (1995) Phobic postural vertigo (154 patients): its association with vestibular disorders. J Audiol Med 4:97–103Google Scholar
  11. 11.
    Eckhardt-Henn A, Best C, Bense S, Breuer P, Diener G, Tschan R, Dieterich M (2008) Psychiatric comorbidity in different organic vertigo syndromes. J Neurol 255:420–428CrossRefPubMedGoogle Scholar
  12. 12.
    Staab JP (2012) Chronic subjective dizziness. Continuum Lifelong Learning Neurol 18:1118–1141CrossRefGoogle Scholar
  13. 13.
    Feuerecker R, Habs M, Dieterich M, Strupp M (2015) Phobic postural vertigo: fewer symptoms in the early morning—a comparison with downbeat nystagmus syndrome and bilateral vestibulopathy. J Neurol Neurosurg Psychiatry (in press)Google Scholar
  14. 14.
    Lempert T, Brandt T, Dieterich M, Huppert D (1991) How to identify psychogenic disorders of stance and gait. A video study in 37 patients. J Neurol 238:140–146CrossRefPubMedGoogle Scholar
  15. 15.
    APA (2013) Diagnostic and statistical manual of mental disorders: DSM-5, 5th edn. American Psychiatric Publishing, WashingtonGoogle Scholar
  16. 16.
    World Health Organisation (1993) The ICD-10 classification of mental and behavioral disorders. Clinical description and diagnostic guidelines. WHO, GenevaGoogle Scholar
  17. 17.
    Brandt T, Strupp M, Dieterich M (2014) Five keys for diagnosing most vertigo, dizziness, and imbalance syndromes: an expert opinion. J Neurol 261:229–231CrossRefPubMedGoogle Scholar
  18. 18.
    Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J et al (2012) Vestibular migraine: diagnostic criteria. Consensus document of the Barany Society and the International Headache Society. J Vestib Res 22:167–172PubMedGoogle Scholar
  19. 19.
    Dieterich M, Brandt T (1999) Episodic vertigo related to migraine (90 cases): vestibular migraine? J Neurol 246:883–892CrossRefPubMedGoogle Scholar
  20. 20.
    Jahn K, Langhagen T, Schroeder AS, Heinen F (2011) Vertigo and dizziness in childhood—update on diagnosis and treatment. Neuropediatrics 42:129–134CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Thomas Brandt
    • 1
    Email author
  • Doreen Huppert
    • 1
  • Michael Strupp
    • 2
  • Marianne Dieterich
    • 2
    • 3
  1. 1.Institute for Clinical Neurosciences and German Center for Vertigo and Balance DisordersUniversity Hospital Munich, Ludwig-Maximilians UniversityMunichGermany
  2. 2.Department of Neurology and German Center for Vertigo and Balance DisordersUniversity Hospital Munich, Ludwig-Maximilians UniversityMunichGermany
  3. 3.SyNergyMunich Cluster for Systems NeurologyMunichGermany

Personalised recommendations