4.2 Vestibulære sykdommer

I ICD-10 er de vestibulære sykdommene, med noen få unntak, klassifisert under koden H81. I ICD-11 er de fleste av de vestibulære sykdommene fordelt i tre grupper kalt akutte, episodiske og kroniske vestibulære syndromer. Denne inndelingen er didaktisk nyttig selv om grensene i praksis noen ganger kan være flytende. ICD-11 inkluderer flere “nye” diagnoser og er et viktig fremskritt innen feltet.

4.2.1 Akutt vestibulært syndrom

Acute vestibular syndrome (ICD-11)
A clinical syndrome of acute-onset, continuous vertigo, dizziness, or unsteadiness lasting days to weeks, and generally including features suggestive of new, ongoing vestibular system dysfunction (e.g., vomiting, nystagmus, severe postural instability). There may also be symptoms or signs suggesting cochlear or central nervous system dysfunction. Acute vestibular syndrome usually connotes a single, monophasic event, often caused by a one-time disorder, but it may instead punctuate a relapsing-and-remitting or stepwise, progressive illness course. Disorders typically presenting this syndrome include vestibular neuritis, acute labyrinthitis, traumatic vestibulopathy, demyelinating disease with vestibular involvement, and strokes affecting central or peripheral vestibular structures.

10 Diseases of the ear or mastoid process
AB30 Acute vestibular syndrome
AB30.0 Vestibular neuritis
AB30.1 Labyrinthitis
AB30.Y Other specified acute vestibular syndrome, e.g.
Acute vestibular syndrome due to acute attack of episodic vestibular disorder
AB30.Z Acute vestibular syndrome, unspecified

4.2.2 Episodisk vestibulært syndrom

Episodic vestibular syndrome (ICD-11)
A clinical syndrome of transient vertigo, dizziness, or unsteadiness lasting seconds to hours, occasionally days, and generally including features suggestive of temporary, short-lived vestibular system dysfunction (e.g., nausea, nystagmus, sudden falls). There may also be symptoms or signs suggesting cochlear or central nervous system dysfunction. Episodic vestibular syndrome usually connotes multiple, recurrent events caused by an episodic disorder with repeated spells (triggered or spontaneous), but may initially present after the first event.

AB31 Episodic vestibular syndrome
AB31.0 Meniere disease
AB31.1 Vestibular migraine
AB31.2 Benign positional paroxysmal vertigo
AB31.3 Superior canal dehiscence syndrome
AB31.4 Disembarkment syndrome
AB31.5 Autoimmune inner ear disease
AB31.6 Vestibular paroxysmia
AB31.7 Vertiginous syndromes
AB31.Y Other specified episodic vestibular syndrome, e.g.
Episodic vestibular syndrome due to orthostatic hypotension
AB31.Z Episodic vestibular syndrome, unspecified

4.2.3 Kronisk vestibulært syndrom

Chronic vestibular syndrome (ICD-11)
A clinical syndrome of chronic vertigo, dizziness, or unsteadiness lasting months to years and generally including features suggestive of persistent vestibular system dysfunction (e.g., oscillopsia, nystagmus, gait unsteadiness). There may also be symptoms or signs suggesting cochlear or central nervous system dysfunction. Chronic vestibular syndrome often connotes a progressive, deteriorating course, but sometimes instead reflects a stable, incomplete recovery after an acute vestibular event, or persistent, lingering symptoms between episodic vestibular events.

AB32 Chronic vestibular syndrome
AB32.0 Persistent Postural-Perceptual Dizziness
AB32.1 Chronic unilateral idiopathic vestibulopathy
AB32.2 Persistent unilateral vestibulopathy after vestibular neuronitis
AB32.3 Unilateral vestibulopathy due to schwannoma
AB32.4 Unilateral vestibulopathy after medical intervention
AB32.5 Chronic bilateral vestibulopathy
AB32.Y Other specified chronic vestibular syndrome
AB32.Z Chronic vestibular syndrome, unspecified

4.2.4 Andre vestibulære sykdommer

Noen vestibulære sykdommer er av ulike grunner fortsatt holdt utenfor klassifikasjonen av de vestibulære syndromene. Andre sykdommer dukker opp flere steder under ulike overskrifter. En mulig årsak kan være at enkelte sykdommer logisk kan høre inn under flere medisinske spesialiteter, og at man har ønsket å åpne for at ulike spesialister kan kode på den måten de selv finner mest naturlig.

Noen ganger blir dette åpenbart forvirrende, særlig ved tilstanden bilateral vestibulopati, som kodes forskjellig avhengig om den er “kronisk” eller “idiopatisk”. En fornuftig løsning på dette kan være å forholde seg til hovedårsaken til at pasienten kommer til undersøkelse og behandling. Hvis svimmelhet er den primære kontaktårsaken, bør diagnosen fortrinnsvis kodes innenfor de vestibulære syndromene, dvs. AB30 - AB32.

Andre relevante koder (ICD-11)
De mest aktuelle kodene for vertigopasienter er uthevet og spefisiert nærmere i hakeparenteser. De øvrige bør stort sett unngås hvis man kan finne bedre alternativer innen de vestibulære syndromene (AB30—AB32).

10 Diseases of the ear or mastoid process
AB34 Disorders of vestibular function
AB32.0 Idiopathic bilateral vestibulopathy
AB32.1 Other peripheral vertigo
AB32.Y Other specified disorders of vestibular function
AB32.Z Disorders of vestibular function, unspecified
AB35 Labyrinthine fistula
AB36 Labyrinthine dysfunction
08 Diseases of the nervous system
8A80 Migraine
8A80.0 Migraine without aura
8A80.1 Migraine with aura
8A80.Y Other specified migraine [incl. benign paroxysmal vertigo of childhood]
8B00 Intracerebral heamorrhage
8B10 Transient ischaemic attack
8B11 Cerebral ischaemic stroke
02 Neoplasms
2A02.3 Benign neoplasm of cranial nerves [incl. vestibular schwannoma]