《头晕》视频文字版.docx

《头晕》视频文字版（该视频中dizziness“头晕”实际指眩晕）Dizziness by Dr. Ashley StrobelObjectives目标Focused History（显著病史）、Physical Exam（体格检查）、Benign VS Emergent （良性VS急性）、When to Image（何时行影像学检查）、Treatment（处理）Benign VS Emergent 良性VS急性NOT central VS peripheral—too complex现已不再区分中枢性及外周性，因其太复杂。Ischemic posterior CVA or bleed is the emergency!!后循环缺血性卒中或出血是急性的。While 25% of CVA presents with dizziness, only 3.2% of dizziness ED visits are for CVA/TIA虽有25%的卒中患者出现头晕，仅3.2%头晕急诊患者被诊为卒中/短暂性脑缺血发作。Peripheral Pathophysiology 外周病理生理Labyrinth and CN 8 迷路与第Ⅷ对脑神经Labyrinth: 3 semicircular canals and otoliths: uticle and saccule 迷路：三个半规管及含有耳石的椭圆囊和球囊。Impulses from labyrinth travel to CN 8(vestibular and cochlear nerves) 冲动由迷路传入第Ⅷ对脑神经（前庭蜗神经）Central Pathophysiology 中枢病理生理Brainstem脑干：vestibular nuclei in medulla and pons 延髓和脑桥之前庭神经核Cerebellum小脑（因其处密闭空间，须觅良法查之）Other contributing factors to dizziness其他对头晕起作用之因素Spinal cord impulses脊神经冲动（后角感觉外周感觉）Occipital lobe impulses枕叶冲动（视觉相关）Dizziness Definition 头晕分类Vertigo=Acute Vestibular Syndrome 眩晕=急性前庭综合征Vertigo: motion, disorientation in space 眩晕：动性或位置性错觉Presyncope: diaphoresis, about to faint or pass out, seeing stars昏厥前期表现：出汗，欲倒，眼冒金星Disequilibrium: difficulty standing upright, assoc with periph neuopathy前兆：难以直立，（没有摔倒而感觉可能摔倒，恶心），伴随有外周神经病。Weakness: organic, fatigue/tired虚弱状态：可为器官性，疲乏/劳累History: Deadly D’sDiplopia 复视Dysarthria 构音障碍Dysphasia 言语障碍Dysphonia 发声困难Dysaesthesia 感觉不良Drop attacks without syncope 无昏厥的摔倒发作Down-is-up distortions (room tilting) 上下颠倒式感觉失真（房间倾斜）（如有上述症状，需要治疗）Acute Vestibular Syndrome: When to worry?急性前庭症状：何时予以关切？Multiple prodromal episodes 多次前驱症状发作（患者自觉即将发生眩晕）Abrupt onset while awake 醒时突然发作Disproportionate vomiting or gait disturbance 异常的呕吐或步态障碍Headache or neck pain 头痛或颈痛Acute new hearing loss (except Meniere’s) 急性新发听觉丧失（除外梅尼埃病）New neurologic symptoms 新发神经症状History for Acute Vestibular Syndrome急性前庭症状病史“Describe to me how you feel without using the word dizzy”“除了使用头晕一词，来描述一下你的感觉”Dizzy in spells? 头晕间断性发作？（一过性/持续性）Triggers? 触发的原因？（站立/卧位/注视）Timing? 时间？（何时开始/何时消失）HI