Management of the patient with chronic dizziness
Management of the patient with chronic dizziness
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DOI：
10.3233/rnn-2010-0530
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发表时间：
2010-01-01
影响因子：
2.8
通讯作者：
Lempert, Th
中科院分区：
文献类型：
--
作者：
Bronstein, A. M.;Lempert, Th
在这篇综述中，我们提出了一个务实的做法，慢性前庭症状的患者。即使是慢性病患者，也应该尝试进行回顾性诊断，以确定患者是如何达到当前状况的。简单的问题可能会确定慢性头晕症状是否开始于良性阵发性位置性眩晕（BPPV），前庭神经炎，前庭偏头痛，梅尼埃病或脑干中风。然后，重要的是要确定原始症状是否仍然存在，在这种情况下，它们需要治疗（例如，重新定位maenouvres用于BPPV，偏头痛预防），或者如果你只是在处理慢性头晕症状。此外，医生或物理治疗师需要确定中枢前庭补偿过程是否由于其他临床问题而受到阻碍，例如视觉问题（斜视、白内障手术）、本体感受缺陷（糖尿病或酒精引起的神经病）、其他神经或矫形问题、缺乏移动性或信心（如害怕跌倒或心理障碍）。还应该进行一般的神经系统检查，以确保患者的“慢性头晕”不是由于神经步态障碍。慢性头晕综合征的治疗是多学科的，但康复和简单的咨询应提供给所有患者。相反，前庭抑制剂或镇静剂应该减少，如果可能的话，停止使用。
In this review we present a pragmatic approach to the patient with chronic vestibular symptoms. Even in the chronic patient a retrospective diagnosis should be attempted, in order to establish how the patient reached the current situation. Simple questions are likely to establish if the chronic dizzy symptoms started as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, vestibular migraine, Meniere's disease or as a brainstem stroke. Then it is important to establish if the original symptoms are still present, in which case they need to be treated (e.g. repositioning maenouvres for BPPV, migraine prophylaxis) or if you are only dealing with chronic dizzy symptoms. In addition the doctor or physiotherapist needs to establish if the process of central vestibular compensation has been impeded due to additional clinical problems, e.g. visual problems (squints, cataract operation), proprioceptive deficit (neuropathy due to diabetes or alcohol), additional neurological or orthopaedic problems, lack of mobility or confidence, such as fear of falling or psychological disorders. A general neurological examination should also be conducted, amongst other reasons to make sure your patient's 'chronic dizziness' is not due to a neurological gait disorder. Treatment of the syndrome of chronic dizziness is multidisciplinary but rehabilitation and simple counselling should be available to all patients. In contrast, vestibular suppressants or tranquilisers should be reduced or, if possible, stopped.