头晕眩晕疾病诊治思路

Thoughts on diagnosis and treatment of dizzy and vertigo diseases

头晕是患者最常见的自述症状,但头晕疾病涉及多个学科,且由于患者的病史描述常常不清楚、不可靠,给临床医生带来极大的挑战。正确的头晕眩晕疾病诊断必须建立于完整而详细的病史和关键的体格检查,将患者分为眩晕、头晕、不稳和晕厥前的1972年标准,比Bárány协会推出的前庭症状分类标准更适用于临床,虽然患者描述病史困难但眩晕持续时间和诱发因素常很明确,关键的体格检查包括自发眼震、体位诱发试验、甩头试验、听力和局灶神经系统体征,临床上依据眩晕疾病的诊断标准,合理选择辅助检查,逐步建立分层诊断思路,全面评估并给予综合治疗才能获得满意疗效。

Dizziness is the commonest chief complaints,and it often presents a significant challenge to the physician,not only because dizziness involves multiple disciplines but also the patient’s description are unclear and unreliable usually.Diagnosis of dizziness must be based on a thorough and detailed history and key physical examinations,the classification established in 1972 was more useful than Bárány criteria,which was traditionally divided into four categories:vertigo,dizziness,disequilibrium,and presyncope.Patients have difficulty describing their symptoms accurately but can consistently identify the timing and triggers.The key physical examination include spontaneous nystagmus,positional provoked test,head impulse test,hearing and focal neurological deficits.Satisfactory results can be achieved only by choosing auxiliary examinations reasonably according to the diagnostic criteria of dizziness,gradually establishing hierarchical diagnosis ideas,and comprehensively evaluating and giving comprehensive treatment.