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. 2020 Apr 24;117(17):300–310. doi: 10.3238/arztebl.2020.0300

Figure 2.

The clinical examination of a patient complaining of vertigo, dizziness, or postural imbalance.

Figure 2

  • a) Inspection for spontaneous nystagmus. This should be performed with and without fixation, with the aid of Frenzel goggles (M glasses, illustrated).

  • b) Clinical head-impulse test. The examiner should look for possible refixation saccades, which indicate dysfunction of the vestibulo-ocular reflex (VOR).

  • c, d) All patients, regardless of their history, should be investigated for positional vertigo with rotation of the head by 45° and simultaneous positioning in the opposite direction. Diagnostic positioning maneuvers (SémontPlus) are shown for c) the right posterior semicircular canal and d) the left posterior semicircular canal.

  • e, f) Romberg test: e) basic test condition with the legs apart and the eyes open; f) advanced test condition with the patient standing on one leg and keeping both eyes closed.