Integrierte Versorgung Schwindel

Zusammenfassung

Schwindel ist eines der häufigsten Symptome in der Neurologie und der Medizin allgemein. Die Diagnose und Therapie als Grundlage einer guten Patientenversorgung wird von vielen Ärzten als schwierig empfunden. Die häufigsten Schwindel-Erkrankungen können im Wesentlichen durch Anamnese und klinische Untersuchung diagnostiziert werden. Ausgedehnte apparative Diagnostik ist in den wenigsten Fällen notwendig oder hilfreich. Die meisten Schwindel­erkrankungen sind gut therapierbar und haben eine exzellente Prognose, wenn sie rechtzeitig erkannt werden und nicht über Jahre chronifizieren. Die integrierte Versorgung ist ein Behandlungskonzept was auf den erhöhten Ressourcenbedarf dieser Patienten eingeht, eine Diagnose festlegt und ein Behandlungskonzept entwickelt um die weitere Chronifizierung der Erkrankung zu verhindern. Hierdurch wird die ambulante Versorgung im Rahmen der bereits bestehenden Möglichkeiten unterstützt und unnötige stationäre Aufenthalte vermieden.

Abstract

Dizziness/vertigo is one of the most frequent symptoms in neurology and medicine in general. The diagnosis and therapy as basis for a good patient management are considered to be difficult by many physicians. The most frequent dizziness/vertigo diseases can in principle be diagnosed by case history and clinical examination. Extensive apparatus diagnostics are necessary and useful only in a few cases. Most dizziness/vertigo diseases are well amenable to therapy and have an excellent prognosis when they are recognised in time and not subject to chronification over several years. Integrated care is a treatment concept that takes account of the high resource requirements of the patient, makes a diagnosis, and develops a therapeutic concept to avoid further chronification of the disease. The outpatient care within the framework of the existing possibilites is supported and unnecessary inpatient stays are avoided thereby.

Schlüsselwörter

Schwindel - Schwindel-Zentrum Essen - integrierte Versorgung - differenzialdiagnose ­Schwindel - phobischer Schwank­schwindel

Keywords

dizziness/vertigo - Dizziness and Vertigo Center Essen - integrated care - differential diagnosis vertigo and dizziness - phobic postural vertigo

• Literatur

• 1 Brandt TDM, Eckhardt-Henn A et al. Schwindel – Diagnostik. 4. ed. Stuttgart, New York: Georg Thieme Verlag; 2008
• 2 Neuhauser HK, Radtke A, von Brevern M et al. Burden of dizziness and vertigo in the community. Arch Intern Med 2008; 168: 2118-2124
• 3 Kattah JC, Talkad AV, Wang DZ et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40: 3504-3510
• 4 Vibert D, Liard P, Hausler R. Bilateral idiopathic loss of peripheral vestibular function with normal hearing. Acta Otolaryngol 1995; 115: 611-615
• 5 Brandt T, Schautzer F, Hamilton DA et al. Vestibular loss causes hippocampal atrophy and impaired spatial memory in humans. Brain 2005; 128: 2732-2741
• 6 Zingler VC, Cnyrim C, Jahn K et al. Causative factors and epidemiology of bilateral vestibulopathy in 255 patients. Ann Neurol 2007; 61: 524-532
• 7 Zingler VC, Weintz E, Jahn K et al. Follow-up of vestibular function in bilateral vestibulopathy. J Neurol Neurosurg Psychiatry 2008; 79: 284-288
• 8 Strupp M, Glaser M, Karch C et al. The most common form of dizziness in middle age: phobic postural vertigo. Nervenarzt 2003; 74: 911-914
• 9 Huppert D, Strupp M, Rettinger N et al. Phobic postural vertigo – a long-term follow-up (5 to 15 years) of 106 patients. J Neurol 2005; 252: 564-569
• 10 Neuhauser HK. Epidemiology of vertigo. Curr Opin Neurol 2007; 20: 40-46
• 11 Guilemany JM, Martinez P, Prades E et al. Clinical and epidemiological study of vertigo at an outpatient clinic. Acta Otolaryngol 2004; 124: 49-52
• 12 Takumida M, Kakigi A, Takeda T et al. Meniere’s disease: a long-term follow-up study of bilateral hearing levels. Acta Otolaryngol 2006; 126: 921-925
• 13 Strupp M, Hupert D, Frenzel C et al. Long-term prophylactic treatment of attacks of vertigo in Meniere’s disease – comparison of a high with a low dosage of betahistine in an open trial. Acta Otolaryngol 2008; 128: 520-524
• 14 Thirlwall AS, Kundu S. Diuretics for Meniere’s disease or syndrome. Cochrane Database Syst Rev 2006; 3 CD003599
• 15 Cohen-Kerem R, Kisilevsky V, Einarson TR et al. Intratympanic gentamicin for Meniere’s disease: a meta-analysis. Laryngoscope 2004; 114: 2085-2091
• 16 Thomsen J, Bretlau P, Tos M et al. Placebo effect in surgery for Meniere’s disease. A double-blind, placebo-controlled study on endolymphatic sac shunt surgery. Arch Otolaryngol 1981; 107: 271-277
• 17 Dieterich M, Brandt T. Episodic vertigo related to migraine (90 cases): vestibular migraine?. J Neurol 1999; 246: 883-892
• 18 Cha YH, Lee H, Santell LS et al. Association of benign recurrent vertigo and migraine in 208 patients. Cephalalgia 2009; 29: 550-555
• 19 Neuhauser H, Leopold M, von Brevern M et al. The interrelations of migraine, vertigo, and migrainous vertigo. Neurology 2001; 56: 436-441
• 20 Neuhauser HK, Radtke A, von Brevern M et al. Migrainous vertigo: prevalence and impact on quality of life. Neurology 2006; 67: 1028-1033
• 21 Brandt T, Dieterich M. Vestibular paroxysmia: vascular compression of the eighth nerve?. Lancet 1994; 343: 798-799
• 22 Hufner K, Barresi D, Glaser M et al. Vestibular paroxysmia: diagnostic features and medical treatment. Neurology 2008; 71: 1006-1014
• 23 Dix MR, Hallpike CS. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Ann Otol Rhinol Laryngol 1952; 61: 987-1016
• 24 Brandt T, Steddin S. Current view of the mechanism of benign paroxysmal positioning vertigo: cupulolithiasis or canalolithiasis?. J Vestib Res 1993; 3: 373-382
• 25 Prokopakis EP, Chimona T, Tsagournisakis M et al. Benign paroxysmal positional vertigo: 10-year experience in treating 592 patients with canalith repositioning procedure. Laryngoscope 2005; 115: 1667-1671
• 26 Lempert T, Tiel-Wilck K. A positional maneuver for treatment of horizontal-canal benign positional vertigo. Laryngoscope 1996; 106: 476-478
• 27 Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 1980; 106: 484-485
• 28 Semont A, Freyss G, Vitte E. Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 1988; 42: 290-293
• 29 Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992; 107: 399-404
• 30 Rahko T. The test and treatment methods of benign paroxysmal positional vertigo and an addition to the management of vertigo due to the superior vestibular canal (BPPV-SC). Clin Otolaryngol Allied Sci 2002; 27: 392-395
• 31 Perez P, Franco V, Cuesta P et al. Recurrence of benign paroxysmal positional vertigo. Otol Neurotol 2012; 33: 437-443