眩晕定位诊断精要.pptVIP

Vertigo WARD 3 定位诊断 周围前庭系统 临床上表现为典型的眩晕发作，持续时间短数秒至10余秒不等，发作与头的位置有关，不伴其他神经系统受累的证据。 辅助检查：双侧听力骨到导气导均差；脑干诱发电位未见异常；头MRI无相关阳性发现。 Definitions: Definitions: Dizziness: Vertigo (spinning or other illusion of movement such as tilting, floating, or impulsion). Vertigo is generally caused by an inner ear disturbance, but can also be cause by a central (brain) disturbance.? Lightheaded sensation, impending faint. Lightheadedness is generally caused by low blood pressure, and may be associated with orthostatic hypotension or syncope. Confusion. Generally caused by metabolic (blood chemistry) disturbances. Spatial discomfort. This category encompasses all types of dizziness not specifically covered by the above, and is especially applicable to dizziness caused by psychiatric disorders. Definitions: Imbalance: Unsteadiness leading to increased risk of fall. Imbalance commonly accompanies dizziness, but can also be independant. There are a large numberof individual causes of imbalance. Drop attack: unprovoked fall without loss of consiousness Hearing disorder: Hearing disorders commonly accompany dizziness caused by ear disorders. They are also common in individuals over the age of 50, with any type of dizziness. (一)眩晕的解剖学基础 (三)眩晕的类别 漂浮性眩晕 旋转性眩晕屡次发作后，可以变为漂浮性。两侧内耳机能丧失时表 现为 jumbling征。快速转动头部或走路时出现视物模糊或振动幻视 。也发生在小脑前庭及中枢前庭系的两侧损害，如小脑蚓部栓塞、脑桥栓塞等。 摇摆性眩晕 见于两侧周围前庭病变，例如链霉素中毒；也见于中枢前庭系两侧同时受侵犯，如小脑蚓部或脑干血管性病变。常表现为身体左右或前后摇晃的感觉。 (三)眩晕的类别 自发性眩晕 系指无明显诱因，突然眩晕发作，可仅犯病一次，或多次反复发作， 前者见于突发性聋、前庭神经元炎、迷路炎等;后者见于美尼尔氏病、短暂性脑缺血发 作、癫痫伴发眩晕等。 (三)眩晕的类别 诱发性眩晕 仅在取某种体位或体动时诱发眩晕，有以下三种情况:①仅在取某种特定体位或头位时诱发眩晕，内耳性者为旋转性眩晕，出现旋转性眼震；小脑蚓部病变引起者出现垂直性眼震，②有慢性周围性前庭疾患，如迷路炎、突发牲聋、内耳骨折、 内耳梅毒等，头部的快速运动、翻身、躺下、屈颈等运动给予半规管、耳石器或颈肌以刺激，造成已得到暂时代偿的前庭系再次不均衡，诱发眩晕；③从卧位或坐位突然站起时或抬头向上看时诱发眩晕，是由于直立性低血压或颈部运动使椎动脉受压引起。 另外，作旋转试验、冷温试验、直流电试验等均能诱发暂时性眩晕，属生理性反应。 (三)眩晕的类别 (四)病因鉴别 前庭神经元炎 有病毒病灶感染史，突然发病，一般无耳聋耳鸣。 (四)病因鉴别 迷路炎 包括浆液性和化脓性迷路炎，有化脓性中耳炎史，尤其胆脂瘤型，瘘管试验多阳性 (四)病因鉴别 外伤性 有颅脑外伤史，可合并有中耳听骨链和迷路前庭损害，亦可累及脑干和中脑。 (四)病因鉴别 美尼尔氏病 为突然发作性眩晕，伴有耳鸣、耳聋和耳胀满感，可