体位性眩晕患者的管理:诊断缺陷和治疗

S. Y. Lavrik, A. S. Borisov, V. Shprakh, I. M. Mikhalevich
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引用次数: 0

摘要

体位性眩晕表现的疾病包括良性阵发性体位性眩晕(BPPV)、前庭偏头痛、脑肿瘤、脱髓鞘等疾病。目的:探讨体位性眩晕的治疗方法。材料和方法。对64例主诉体位性眩晕的患者进行了检查。进行了临床和神经学检查、耳神经学检查,包括体位诊断测试、Frenzel视频眼镜自发性眼球震颤评估、平滑追踪测试、扫视测试、头摇测试、福田测试。在大多数(70%)的病例中,眩晕的转诊诊断为慢性脑缺血、椎动脉综合征和植物性血管张力障碍。然而,这些诊断都没有被证实是眩晕的主要原因。最常见的错误(62.5%)是仅根据主诉做出诊断,而没有进行耳神经学检查和体位检查。眩晕最常见的原因是BPPV(64.6%)、前庭偏头痛(20.3%)和前庭神经炎(12.5%)。在体位性眩晕的诊断中,临床表现、耳神经系统检查和体位性眼球震颤特征的评价起主导作用。
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Managing patients with positional vertigo: diagnostic pitfalls and treatment
The spectrum of diseases manifested by positional vertigo includes benign paroxysmal positional vertigo (BPPV), vestibular migraine, brain tumors, demyelinating and some other diseases.Objective: to study the common practice of managing patients with positional vertigo.Material and methods. 64 patients with complaints of positional vertigo were examined. Clinical and neurological examination, otoneurological examination, including positional diagnostic tests, assessment of spontaneous nystagmus in Frenzel video glasses, tests of smooth tracking, saccades, head shaking, Fukuda test were carried out.Results. In the majority (70%) of cases, the referral diagnoses for vertigo were chronic cerebral ischemia, vertebral artery syndrome, and vegetative-vascular dystonia. However, none of these diagnoses was confirmed as the leading cause of vertigo. The most common mistake (62.5%) was making a diagnosis only on the basis of complaints, without an otoneurological examination and positional tests. The most common causes of vertigo were BPPV (64.6%), vestibular migraine (20.3%) and vestibular neuronitis (12.5%).Conclusion. In the diagnosis of positional vertigo, the evaluation of clinical manifestations, otoneurological tests and characteristics of positional nystagmus plays a leading role.
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