最终版_头晕之误区课件.pptxVIP

头晕眩晕;什么是头晕？;头晕为由视觉、脑部、内耳平衡及胃肠道疾患所导致的无痛性头部不适。头晕是个难以界定的医学术语，非专业人员常用之以描述从头重脚轻、不稳到眩晕等多种情况;1972年，Drachman和Hart将头晕定义为非特异性的一组症状，包括： 眩晕（vertigo） 失衡和（或）不稳（disequilibrium） 晕厥前（presyncope） 非特异的头重脚轻（lightheadness）;Vertigo is the sensation of spinning or having ones surroundings spin about them. Many people find vertigo very disturbing and often report associated nausea and vomiting. Disequilibrium is the sensation of being off balance, and is most often characterized by frequent falls in a specific direction. This condition is not often associated with nausea or vomiting. Presyncope is muscular weakness and feeling faint as opposed to syncope, which is actually fainting. lightheadness is often psychiatric in origin. It is a diagnosis of exclusion and can sometimes be brought about by hyperventilation. ;头晕的原因是什么 ;误解1：椎基底动脉供血不足;Posterior Circulation Ischemia: Then, Now, and Tomorrow;VBI是怎么来的、如何演变的呢;21世纪50年代，神经病学家发现在大的脑梗死之前会出现一过性的可逆的症状如肢体无力、麻木、复视、头晕等;60至80年代，由于CT以及颈内动脉剥脱术技术的发展，使得对前循环缺血性卒中的机制有了进一步认知;之后Caplan等等进行了大量研究，从根本上改变了对后循环缺血性卒中的认识;Posterior Circulation Ischemia: Then, Now, and Tomorrow;结论;结论;单纯头晕是后循环TIA么 ;Vertebral-artery disease can cause transient attacks of vertigo that are usually accompanied by other brain-stem or cerebellar symptoms. In our experience, isolated episodes of vertigo continuing for more than three weeks are almost never caused by vertebrobasilar disease;头晕;头晕/眩晕怪圈;头晕/眩晕怪圈;头晕/眩晕怪圈;误解2：颈椎病;Mechanical compression of the extracranial vertebral artery during neck rotation;1108例有心脑血管危险因素的患者进行转颈后多普勒超声检查;结论;;目前所有的关于颈性眩晕的临床研究存在以下三个缺陷：（1）无法证实诊断（2）缺乏特异性实验检查方法（3）无法解释有些患者有明显颈痛却无眩晕，而有些主诉严重眩晕却仅有中度疼痛。目前对???研究有一定理论意义却无实际临床相关性。;结论;到底该怎么诊断;;;前庭周围性（64.7%）;Vertigo clinic of Ludwig Maximilian University and the German Center for Vertigo and Balance Disorders T brandt;;小结;一旦被误诊极易出现严重的甚至是致命的后果;对于头晕患者行头颅MRI体征;急性前庭综合症患者，早期MRI-DWI假阴性率为12%;小于10mm的梗死灶，早期头颅MRI-DWI阳性率仅为47%;提示急性脑梗死/TIA的体征;HINTS在急性前庭前庭综合症中诊断脑梗死：