最后审阅: 20 四月 2022
最后更新: 08 二月 2022

简介

疾病
描述

Patients may use the term dizziness to describe vertigo, pre-syncope, disequilibrium and lightheadedness (or non-specific dizziness). The most common causes of dizziness in primary care settings are benign paroxysmal positional vertigo (vertigo caused by the presence of a canalith in the vestibular apparatus), Meniere's disease, and acute vestibular neuritis (vestibular neuronitis).[3] These all present with vertigo symptoms.

外周性前庭疾病的特征是突发性的重症眩晕,持续时间通常不足 30 秒,并由特定的头部运动诱发(如仰头或低头、起床、转头或翻身到床另一侧)。[4] Diagnosis is clinical with other key diagnostic factors including episodic vertigo (repeated attacks over days, weeks, or months), absence of associated neurological or otological symptoms, normal neurological examination, and positive Dix-Hallpike manoeuvre (posterior canal BPPV) or supine lateral head turn (lateral canal BPPV).

Auditory and vestibular disease characterised by an episodic, sudden onset of vertigo; hearing loss and roaring tinnitus; and a sensation of pressure or discomfort in the affected ear. Vertigo lasts minutes to hours and may be associated with nausea and vomiting. Hearing loss is usually worse during acute attacks, especially in early stages of the disease. As the disease progresses, hearing loss increases in severity and may become constant. Risk factors for Meniere’s disease include family history, recent viral infection, and autoimmune disorders.

一种累及耳蜗迷路与内耳前庭系统的炎性疾病。 病毒性内耳炎通常与既往上呼吸道感染相关。 其他致病病毒包括水痘带状疱疹病毒、巨细胞病毒、腮腺炎、麻疹、风疹和 HIV。 细菌性迷路炎与急性或慢性中耳炎、脑膜炎和胆脂瘤具有相关性。 某些自身免疫性疾病也可能引发迷路炎(如 Cogan 综合征或 Behcet 综合征)。[5] Patients typically present with severe room-spinning vertigo and associated nausea and vomiting. They may have unilateral hearing loss and tinnitus. Most acute episodes are short-lived and self-limited.

前庭性偏头痛

眩晕的常见病因,自发性发作性眩晕的最常见病因。[1][6] 大约 10% 的偏头痛患者会出现前庭性偏头痛。[1] 症状包括自发性体位性眩晕、头部运动性眩晕/头晕和共济失调、数秒至数天不等的持续时间以及无偏头痛相关性头痛。[1][6] 诊断性症状可能包括畏光、声音恐怖症或预兆。[1] 治疗方法与偏头痛的推荐疗法类似,包括饮食疗法和改善生活方式以及预防性治疗(β 受体阻滞剂、钙-通道阻滞剂和三环类抗抑郁剂)。[6]

A common cause of unilateral peripheral vestibular loss, vestibular neuritis (vestibular neuronitis) is an acute peripheral vestibulopathy due to reactivation of a viral infection, most commonly herpes simplex virus. It affects the vestibular ganglion, vestibular nerve, labyrinth, or a combination of these sites.[7]

创伤后眩晕

通常发生在钝性头部外伤之后,如跌倒、撞击或机动车辆事故。 主要症状可能为外伤性外淋巴瘘或者外伤后美尼尔病。[8] 患者可能会主诉眩晕、失调、耳鸣、压迫感、头痛和复视。 其他病因包括手术(中耳手术、耳蜗植入术)和潜水。[9][10][11] 上半规管裂须与创伤后眩晕进行鉴别;前者的特征是与巨响和/或中耳压力变化有关的眩晕发作。[12]

脑血管病因

头晕是脑血管事件的常见病征之一。 小脑卒中(由于梗塞或出血所致)可有与外周性神经病因性眩晕相似的临床表现,如剧烈眩晕、恶心和呕吐。 眼震(双侧或垂直)可能提示中枢性眩晕。 其他神经系统体征包括肢体共济失调和步态障碍。 小脑卒中患者通常无法自行站立,甚至无法自行睁眼,但是急性前庭神经炎或迷路炎患者通常可以自行站立和睁眼。 不同于外周神经病因学眩晕,头-脉冲试验的结果呈阴性(头部突然旋转时,眼睛无需扫视调整)。[13] Urgent magnetic resonance imaging should be requested in all patients with acute vertigo who have significant risk factors for a cerebellar stroke, such as hypertension, diabetes mellitus, smoking, and cardiovascular disease, since it is possible that central signs on examination may not present.

肿瘤原因

Intracranial tumours and vestibular schwannomas may present with vertigo, as well as other symptoms such as signs of intracranial pressure (e.g., headache, altered mental status, nausea, and/or vomiting) and gait abnormality. Cranial nerve deficits may also manifest.[13] Neuroimaging with computed tomography/magnetic resonance imaging is essential.

撰稿人

作者

Editorial Team

BMJ Publishing Group

利益声明

This overview has been compiled using the information in existing sub-topics.

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