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Symptoms and Signs of Neuro-otologic Disorders

Newman-Toker, David E. MD, PhD, FAAN

doi: 10.1212/01.CON.0000421618.33654.8a
Review Articles

Purpose of Review: Symptoms and signs of neuro-otologic disorders are critical components in the diagnostic assessment of patients with vestibular symptoms such as vertigo, dizziness, unsteadiness, and oscillopsia. Most diagnoses can be accomplished at the bedside. An understanding of key diagnostic principles is essential for all practicing neurologists, who are often faced with determining whether such patients warrant urgent diagnostic testing or hospital admission. This article introduces readers to core concepts and recent advances in the understanding of directed history taking and physical examination in patients with vestibular symptoms or suspected neuro-otologic disorders.

Recent Findings: International consensus definitions for vestibular symptoms have recently been published. During the past 5 years, a growing body of scientific evidence has demonstrated that the traditional approach to bedside diagnosis of patients with vertigo and dizziness is inadequate. Former teaching that history taking should first rely on categorizing symptoms by type (eg, vertigo, presyncope, disequilibrium, nonspecific dizziness) has been replaced by an emphasis on categorizing timing and triggers for vestibular symptoms, which focuses the clinician’s attention on four key syndromic patterns: (1) acute, spontaneous, prolonged vestibular symptoms; (2) episodic, positional vestibular symptoms; (3) episodic, spontaneous vestibular symptoms; and (4) chronic unsteadiness (with or without oscillopsia). Each of these categories delineates a relatively narrow differential diagnosis within which a focused examination distinguishes between benign common causes and dangerous uncommon ones.

Summary: A focused approach to bedside assessment of patients with vestibular symptoms is essential for accurate and efficient diagnosis. All neurologists should be aware of major recent advances.

Address correspondence to Dr David E. Newman-Toker, Johns Hopkins Hospital, Department of Neurology, 600 North Wolfe Street, Meyer 8-154, Baltimore, MD 21287,

Relationship Disclosure: Dr Newman-Toker has received honoraria for speaking from Janssen Pharmaceuticals, Inc., and consulting fees from Pierre Fabre. He has received research support from the Agency for Healthcare Research and Quality and the NIH.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Newman-Toker reports no disclosure.

© 2012 American Academy of Neurology
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