Objective: To estimate the value of static posturography (PUG) to detect functional postural instability in patients with acute vertigo syndromes in an emergency department

Background: In patients with functional vertigo it is suggested, that an inadequate recognition of the different regulating inputs may lead to an inappropriate neuromuscular regulation of posture with increased muscle cocontractions and higher body sway [1,2]. The static posturography (PUG) is a simple und quick examination to analyse different forms of ataxia and is useful in the detection of functional vertigo [3].

Method: In our emergency department we examined 217 patients with vertigo as the leading symptom. A questionnaire was used for structured medical history including Romberg´s test and gait tests. All emergency examinations required for clarification were carried out. PUG was performed in three tasks: eyes open, eyes closed and visual feedback for one minute each. Diagnoses were based on literature research and our neurological society guidelines. Significance test (p ≤ 0.05) was performed with Fisher’s exact test.

Results: PUG had a significant benefit in confirming functional vertigo and shows factors of an increased non-organic disorder of postural control in Meniere’s disease and vestibular migraine. PUG was superior to clinical examination: 47% of the patients with a phobic pattern had normal findings in the Romberg´s test and 57% of them had normal findings in the gait tests.

Conclusion: PUG is a simple tool to detect a non-organic pattern in patients with disturbances of postural control in the neurological emergency department. Furthermore, it seems to be a valuable complement to the clinical examination. Besides, PUG provides further evidence of increased functional comorbidity in patients with Meniere’s disease and vestibular migraine.

References: 1. Wuehr M, Schniepp R et al. (2013) Inadequate interaction between open- and closed-loop postural control in phobic postural vertigo. J Neurol 260:1314–1323
2. Wuehr M, Schniepp R et al. (2017) Distracting attention in phobic postural vertigo normalizes leg muscle activity and balance. Neurology 88:284–288
3. Krafczyk S, Brandt T et al. (2006) Artificial neural network: A new diagnostic posturographic tool for disorders of stance. Clinical neurophysiology 117:1692–8

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MDS Abstracts - https://www.mdsabstracts.org/abstract/vertigo-sway-pattern-indicating-a-functional-movement-disorder/