Introduction: Cervicogenic vertigo is a non-specific sensation of altered spatial orientation, due to abnormal afferences to the vestibular nuclei, originating from damaged articular or muscular receptors in the upper cervical spine. This symptom can be related to problems in the central nervous, cardiovascular, vestibular, or musculoskeletal systems. The purpose of this narrative review is to evaluate the contents of current scientific literature on the examination of cervicogenic vertigo in order to suggest a possible diagnostic pathway leading to its correct identification. Methods: The literature search was conducted from January to June 2011 in the following databases: PubMed, PEDro, Cochrane. Studies published in the last 20 years, pertaining the diagnosis of vertigo and clinical testing in physical therapy, were included. Results: Given the deficiency of validated clinical tests in the scientific literature, differential diagnosis relies on the exclusion of other dysfunctions that produce vertigo. This process is based on: collection of subjective information and the exclusion of red flags; screening tests to rule out orthostatic hypotension, vertebro-basilar insufficiency, neurologic pathology, and vestibular system dysfunction. Diagnosis of cervicogenic vertigo will then have to be confirmed by a thourough examination of the cervical spine and a trial treatment. Conclusion: Diagnostic accuracy data for the identification of cervicogenic vertigo are absent or insufficient to support evidence-based patient management. Further studies are required to explore this topic, with the intent of validating not only instrumental testing, but also feasible clinical testing for the correct identification of cervicogenic vertigo
Introduzione: La “cervicogenic dizziness” è una sensazione non specifica di alterato orientamento nello spazio, dovuta ad anormali input afferenziali ai nuclei vestibolari provenienti da recettori articolari o muscolari danneggiati nel rachide cervicale superiore.Questa sintomatologia può essere ricondotta a problematiche del sistema nervoso centrale, cardiovascolare, vestibolare, e muscoloscheletrico. Lo scopo di questa revisione narrativa è di valutare il materiale presente in letteratura sull’esame clinico della “cervicogenic dizziness” per proporre un possibile iter diagnostico che ne identifichi la presenza. Metodi: La ricerca bibliografica è stata effettuata nel periodo da gennaio a giugno 2011 nelle banche dati PubMed, Pedro, Cochrane includendo le pubblicazioni degli ultimi 20 anni.Sono stati inclusi gli studi inerenti alla diagnosi di vertigine ed ai test clinici di pertinenza fisioterapica. Risultati:Vista la carenza di test clinici validati in letteratura, il procedimento diagnostico più utilizzato è quello effettuato per esclusione delle altre problematiche in grado di causare vertigine. Questo processo si avvale di: raccolta dei dati anamnestici ed esclusione di bandiere rosse, esame di screening per l’esclusione di ipotensione ortostatica, insufficienza vertebro basilare, patologia neurologica e problematiche del sistema vestibolare periferico. La diagnosi cercherà conferma nell’esame fisico del rachide cervicale e nel trattamento di prova. Conclusioni: I dati di accuratezza diagnostica per i test di individuazione della “cervicogenic dizziness” sono in gran parte assenti o insufficienti a sostenere una gestione del paziente basata sulla ricerca scientifica. Ulteriori studi potranno approfondire tale argomento con il tentativo di validare, non solo test strumentali, ma anche test attuabili nella pratica clinica per l’individuazione della “cervicogenic dizziness”
Clinical diagnostic criteria for cervicogenic dizziness: review of the literature. Criteri diagnostici per vertigine cervicogenica: revisione narrativa della letteratura
VANTI, CARLA
2013
Abstract
Introduction: Cervicogenic vertigo is a non-specific sensation of altered spatial orientation, due to abnormal afferences to the vestibular nuclei, originating from damaged articular or muscular receptors in the upper cervical spine. This symptom can be related to problems in the central nervous, cardiovascular, vestibular, or musculoskeletal systems. The purpose of this narrative review is to evaluate the contents of current scientific literature on the examination of cervicogenic vertigo in order to suggest a possible diagnostic pathway leading to its correct identification. Methods: The literature search was conducted from January to June 2011 in the following databases: PubMed, PEDro, Cochrane. Studies published in the last 20 years, pertaining the diagnosis of vertigo and clinical testing in physical therapy, were included. Results: Given the deficiency of validated clinical tests in the scientific literature, differential diagnosis relies on the exclusion of other dysfunctions that produce vertigo. This process is based on: collection of subjective information and the exclusion of red flags; screening tests to rule out orthostatic hypotension, vertebro-basilar insufficiency, neurologic pathology, and vestibular system dysfunction. Diagnosis of cervicogenic vertigo will then have to be confirmed by a thourough examination of the cervical spine and a trial treatment. Conclusion: Diagnostic accuracy data for the identification of cervicogenic vertigo are absent or insufficient to support evidence-based patient management. Further studies are required to explore this topic, with the intent of validating not only instrumental testing, but also feasible clinical testing for the correct identification of cervicogenic vertigoI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
