心因性頭暈的診斷治療心因性頭暈的診斷治療1心因性頭暈的診斷治療DiagnosisandTreatmentofPsychogenicDizziness2019-05-09心因性頭暈的診斷治療2內(nèi)容概要一、頭暈的概念及癥候、心因性頭暈的發(fā)生率三、心因性頭暈的臨床表現(xiàn)四、心因性頭暈的發(fā)病因素五、心因性頭暈的治療六、心因性頭暈的鑒別診斷七、心因性頭暈的表現(xiàn)舉例2020/5/4海軍總醫(yī)院神內(nèi)容概要3、頭暈的概念及癥候Dizziness:ADiagnosticApproachROBERTEPOST,MD,VirtuaFarmilyMedicineResidencyVoorhees,NewJeLORIM.DICKERSON,PharmD,MedicalUniversityofSouthCarolina,Charleston,SouthCarolinaDizzinessaccountsforanestimated5percentofprimarycareclinicvisits.Thepatienthistorycangenerallyclassifdizzinessintooneoffourcategories:vertigoorlightheadedness,Themaincausesofvertigoarebenignparoxysmalpositionalvertigo,Meniease,vestibuletisandlabyrinthitis.Manymedicationscancausepresyncope,andregimensshouldbeassessedinpatientswiththistypeofdizziness,Parkinsondiseaseanddiabeticneuropathyshouldbeconsideredwiththediagnosisofdisequilibrium.Psychiatricdisorders,suchasdepression,anxiety,andhyperventilationsyndrome,cancausevaguelightheadedness.Thedifferentialdiagnosisofdizzinesscanbenarowedwitheasy-to-performphysicalexaminationtests,includingevaluationfornystagmus,theDix-Hallpikemaneuver,andortho-staticbloodpressuretesting.Laboratorytestingandradiographyplaylittleroleindiagnosis.Afinaldiagnosisisnotobtainedinabout0percentofcases.TreatmentofvertigoincludestheEpleymaneu-ver(canalithrepositioning)andvestibularrehabilitationforbenignparoxysmalpositionalvertigo,intratympanicdexamethasoneorgentamicinforMenieredisease,andsteroidsforvestibularneuritis.Orthostatichypotensionthatcausespreynopecanbetreatedwithalphaagonists,mineralocorticoids,orlifestylechanges.Disequilib-riumandlightheadednesscanbealleviatedbytreatingtheunderlyngcause(AmFanPhysician.2010;82(4):361-368.Copyright2010AmericanAcademyofFamilyPhysicians.y、頭暈的概念及癥候4頭暈的概念及癥候“頭暈[dizziness]”的概念分類(lèi)頭昏[ghtheadedness]:頭沉,大腦不清晰感眩暈[vertigo]:運(yùn)動(dòng)錯(cuò)覺(jué)(視覺(jué)及主觀(guān)感覺(jué)旋轉(zhuǎn))暈厥前狀態(tài)[presyncope]:暈,眼前發(fā)黑,心慌失衡[disequilibrium:不穩(wěn)感。一海軍總醫(yī)院神頭暈的概念及癥候5、頭暈的概念及癥候Table1.MainCategoriesofDizzinessPercentagepatiantscategoryDascnDNonwithdizzinessvertIcFalsesenseofmotion45to54possiblyspinningsensatioDIsequilibriumoff-balanceorwobblyupto16PresyncopeFeelIngoflosingconsdoLnessorLightheadednessvaguesymptomsApproxlmatelypossiblyfeelIngdiconnectedwlththeenvIronmentInformationfromreferences4.5.4and8、頭暈的概念及癥候6頭暈/眩暈的概念及癥候Table3.SelectedCausesofDizzinesscategoryMagnesiccenaBenignparoxysmalvertIgoLooseotolithinsemldrauarcanalscausingPosltlvefindIngswithDIx-Haafalsesansaofmotionmaneuver,epodevertiHyperventIlationghtheadednes,Hyperventilationcausingresplratoryalkalosis;SymptomsreproducedwlthvoluntaryunderlyinganxetymayprovokethehyperventillatlonMenieredseasevertigoIncreasedendlymphatkfluidintheInnerearEpisodicvertionwIthhearinglossMigrainousvertigohypothesislsthattrigeminalnucleistimulationcausesnystagmusduringatleasttwoepisodesofvertiOrthostatetopInbloodpressureonposltiondangeSystolicbloodpressuredecreaseof20mmhypotensionusingdecreasedbloodfiowtothebrain,Ho,dlastolicbloodpressuredeceasedverseeffectofmultiplemedicationsof10mmH,orapubeincreaseofiseeTable2)3obeatspermInuteParkinsondeaseisequllbriumDysfunctioningaitcausingimbalancewinaandpossiblePeripheralneuropathyDlsequllbriumDecreasedtactileresponsewhenwalkingDecreasedsenslowerextremities,touchhegroundeadingtombalanceMnformationromeferences4,7,B,and13through20.頭暈/眩暈的概念及癥候7心因性頭暈的發(fā)生率神經(jīng)科頭暈門(mén)診200例患者的病因分析NEUROLOGY2019:56436Table2Diagosesin200patientswithandwithoutmigrainepresentingfoaneurologicdumainesclinicDizzinessdiniepatientschmegrouppatientswithmigrainewithoutmigraineia=125)Benignparoxysmalpositionalvertige61(31)21t2540(32DetinitemigrainousvertigO1419Vestibulopathyafunknownorgin心因性頭暈占到20%,其中有偏頭痛史的心因性叫頭暈占6%,無(wú)偏頭痛史占14%Vestibularneuritis6{5心因性頭暈的發(fā)生率8、心因性頭暈的發(fā)生率Brandt20195353例神經(jīng)科頭暈門(mén)診患者的病因分析TABLE1TheFrequencyofDifferentvertigo/DizzinesSyndromesin5353PatientsSeeninaNeurologicalDizzinessUnitDiagnosisPercentage(%oBenignparoxysmalItionalvertigo99之18.5699Vestibularmigraine55310.3Meniere'sdisease4448.3Vestibularneuritis40teralvestibulopatVestibularparoxysmic173Perilymphfistula0.4Unknownvertigosyndromes214Otherdisorders630l1.8、心因性頭暈的發(fā)生率9回msP加w某m4)80JournalofPsychosomaticResearchELSEVIERShortcommunicationAnxious,introvertedpersonalitytraitsinpatientswithchronicsubjectivedizzinessJeffreyPStaab*,DanielE.RoheScottD.Z.Eggers,NeilTShepards種如山D可知。M《tMNARTICLEINFOABSTRACTwbcschroksDciedizzinessISD)isaneurutkgidisorderadpersistentnot-ermiginaisdainesA中會(huì)d9Mrbe2013ronucdDnetMethdsDatawervabtuctedrwueapwctiwlytromdialrwardaf40patentwladcnaandironsaherthanCSDplusco-exisnnganxeryaespenalitytraitsleafedwattleNEDPeisonirynventary-Revied(NEO-R).andtemperamentsarHATX-adetyseurDSMIwwnthnrexciteerletempetmentsstmglyasdatelwiCsDandmayheaniskadnrluropingsyndronec2013HeverincAllrightsreserved.回msP加w某m4)8010failuretoreturntonormalposturalcontrolafteradaptingtothedemandsofacutevestibularcrises11CSDisnotarareornewconditionitisthesecondmostcommoncauseofdizzinessintertiaryneurotologycentersthattrackit1.Phys-icalsymptomsofCSDaresimilartothoseofphobicposturalvertigo(PPV),whichwasdescribedinGermany27yearsago6].However,thedefinitionofPPvincludedmildanxietyanddepressivesymptomsandobsessivecompulsivepersonalitytraits6thatwerenotretainedinthedefinitionofCSD.Thisconceptualrefinementparallelschangesinconstructsofirritablebowelsyndrome(IBs)fromearlypsychos-maticformulationsthatincludedanxietyanddepressivesymptoms,StaabJP,etal.JPsychosomaticRes,2019,76:80-832020/5/4海軍總醫(yī)院神經(jīng)內(nèi)科failuretoreturntonormalpo11心因性頭暈的診斷治療課件12心因性頭暈的診斷治療課件13心因性頭暈的診斷治療課件14心因性頭暈的診斷治療課件15心因性頭暈的診斷治療課件16心因性頭暈的診斷治療課件17心因性頭暈的診斷治療課件18心因性頭暈的診斷治療課件19心因性頭暈的診斷治療課件20心因性頭暈的診斷治療課件21心