Tarnutzer Alexander Andrea, Kerkeni Hassen, Diener Suzie, Kalla Roger, Candreia Claudia, Piantanida Renato, Maire Raphaël, Welge-Lüssen Antje, Budweg Joris, Zwergal Andreas, Dlugaiczyk Julia
Neurology, Cantonal Hospital of Baden, Baden, Switzerland.
University of Zurich (UZH), Zurich, Switzerland.
HNO. 2025 Jun 17. doi: 10.1007/s00106-025-01599-z.
Vertigo and dizziness belong to the most common leading symptoms in clinical practice. Their differential diagnosis, however, often imposes a challenge.
This work aims to provide evidence-based and practice-oriented recommendations for diagnosis and treatment of vertigo and dizziness for primary care providers.
The consensus statement of an interdisciplinary working group following a national survey among Swiss primary care physicians and neurotology specialists (neurologists, otorhinolaryngologists) is presented. The associated literature search in PubMed was conducted up to October 2024.
Structured history taking and clinical neurotological examination form the basis for the differential diagnosis of the various acute (AVS), episodic (EVS), and chronic (CVS) vestibular syndromes (AVS: e.g., stroke or acute unilateral vestibulopathy; EVS: e.g., benign paroxysmal positional vertigo [BPPV], Menière's disease, vestibular migraine, vestibular paroxysmia; CVS: e.g., bilateral vestibulopathy, persistent postural perceptual dizziness). The present paper covers the following topics: i) "red flags" for a potentially dangerous cause in patients with acute vertigo/dizziness/gait and balance disorders; ii) essential clinical neurotological examination steps; iii) diagnostic and therapeutic maneuvers for posterior and lateral canal BPPV; iv) the most important therapeutic strategies for the vestibular syndromes named above; and v) the top 10 recommendations regarding history taking, diagnosis, and treatment of vertigo and dizziness in clinical practice. This review aims to serve as a clinical companion for physicians of all specialties dealing with the primary diagnosis and treatment of vertigo and dizziness.
眩晕和头晕是临床实践中最常见的主要症状。然而，它们的鉴别诊断往往具有挑战性。
本研究旨在为基层医疗服务提供者提供基于证据且以实践为导向的眩晕和头晕诊断与治疗建议。
介绍了一个跨学科工作组在对瑞士基层医疗医生和神经耳科学专家（神经科医生、耳鼻喉科医生）进行全国性调查后达成的共识声明。截至2024年10月在PubMed上进行了相关文献检索。
结构化病史采集和临床神经耳科学检查是各种急性（急性前庭综合征，AVS）、发作性（发作性前庭综合征，EVS）和慢性（慢性前庭综合征，CVS）前庭综合征鉴别诊断的基础（AVS：例如中风或急性单侧前庭病变；EVS：例如良性阵发性位置性眩晕[BPPV]、梅尼埃病、前庭性偏头痛、前庭阵发症；CVS：例如双侧前庭病变、持续性姿势性感知性头晕）。本文涵盖以下主题：i）急性眩晕/头晕/步态和平衡障碍患者潜在危险病因的“红旗”；ii）基本的临床神经耳科学检查步骤；iii）后半规管和水平半规管BPPV的诊断和治疗手法；iv）上述前庭综合征最重要的治疗策略；v）临床实践中关于眩晕和头晕病史采集、诊断和治疗的前10条建议。本综述旨在为所有从事眩晕和头晕初步诊断和治疗的专科医生提供临床参考。
