急性头晕或眩晕患者的床旁检查

The use of the bedside examination to diagnose patients with acute dizziness and vertigo

头晕或眩晕病因复杂，基于主观感觉的性质鉴别病因不确定性较大，依靠头晕的触发因素、持续时间的新的诊断思维丰富了眩晕医学内容。不少急诊医生对头晕的床旁检查缺乏认识和掌握，并过度依赖和相信神经影像学检查，这一方面导致了头晕危险疾病如卒中的误诊，另一方面对内耳原因疾病产生不必要的神经影像学检查和过度医疗并失去针对性治疗。笔者根据目前头晕或眩晕的新诊断模式，重点介绍如何应用床旁检查准确诊断急性头晕或眩晕及其他类似前庭症状，以期提高急诊医生的诊断水平，降低误诊率，节约医疗资源，改善患者的生活质量。

The causes of dizziness and vertigo were complex. The traditional diagnostic paradigm was based on symptom quality-＂ what do you mean dizzy.9＂ According to this system, a patient with ＂ verti- go＂ has a different list of possible causes than those who endorse ＂ lightheadedness＂. The new diagnostic paradigm was based on their description of the timing, triggers of symptom strengthened the context of the vertigo medicine. More emergency physicians （EPs） lacked a significant knowledge regarding bedside ex- amination and extensively convinced neuroimaging, resulting in misdiagnosis of serious causes such as stroke, unnecessary use of neuroimaging, and failure to institute specific treatment for many patients with in- ner ear causes of dizziness. This article focuses on how to use bedside physical examination to more accu- rately diagnose patients who present with acue dizziness, vertigo, or other similar vestiblar symptoms. This, in turn, could lead to lower rates of misdiagnosis, decrease utilization of expensive imaging studies, and in- crease in prompt, and correct treatments, thereby to improve patient outcomes.