Kroenke K, Lucas C A, Rosenberg M L, Scherokman B, Herbers J E, Wehrle P A, Boggi J O
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
Ann Intern Med. 1992 Dec 1;117(11):898-904. doi: 10.7326/0003-4819-117-11-898.
To determine the causes of persistent dizziness in outpatients.
Consecutive adult outpatients presenting with a chief complaint of dizziness.
Four clinics (internal medicine, walk-in, emergency room, and neurology) in a teaching hospital.
Of 185 patients presenting during the 10-month study period, 51 (28%) had minimal or no dizziness at 2-week follow-up. Of the remaining 134 patients, 100 completed the study protocol (mean age, 62 years; range, 20 to 85 years).
Evaluation included a detailed study questionnaire, standardized physical examination, vestibular testing by a neuro-ophthalmologist, laboratory tests, audiometry, and a structured psychiatric interview. Data were abstracted onto a standard form and reviewed by three raters. Raters independently assigned diagnoses using explicit criteria, with the final cause determined by consensus.
Primary causes of dizziness included vestibular disorders (54 patients), psychiatric disorders (16 patients), presyncope (6 patients), dysequilibrium (2 patients), and hyperventilation (1 patient); dizziness was multicausal in 13 patients and of unknown cause in 8 patients. Many of those with a single primary cause, however, had at least one other condition contributing to their dizziness; only 52% of patients had a single "pure" cause. Thirty patients had a potentially treatable primary cause, the most common being benign positional vertigo (BPV) (16%) and psychiatric disorders (6%). Central vestibulopathies detected in 10 patients were presumably vascular or idiopathic in origin. No brain tumors or cardiac arrhythmias were found.
Vestibular disease and psychiatric disorders are the most common causes of persistent dizziness in outpatients. In about 50% of patients with dizziness, more than one factor causes or aggravates symptoms. Life-threatening causes were rare, even in our elderly population.
确定门诊患者持续性头晕的病因。
以头晕为主诉的连续成年门诊患者。
一家教学医院的四个科室（内科、即时就诊、急诊室和神经内科）。
在为期10个月的研究期间就诊的185例患者中，51例（28%）在2周随访时头晕轻微或无头晕。其余134例患者中，100例完成了研究方案（平均年龄62岁；范围20至85岁）。
评估包括详细的研究问卷、标准化体格检查、神经眼科医生进行的前庭测试、实验室检查、听力测定和结构化精神科访谈。数据被录入标准表格并由三名评估者审核。评估者使用明确的标准独立做出诊断，最终病因通过共识确定。
头晕的主要病因包括前庭疾病（54例）、精神疾病（16例）、晕厥前状态（6例）、平衡失调（2例）和换气过度（1例）；13例患者头晕为多因素导致，8例病因不明。然而，许多单一主要病因的患者至少还有一种其他情况导致其头晕；只有52%的患者有单一“纯粹”病因。30例患者有潜在可治疗的主要病因，最常见的是良性阵发性位置性眩晕（BPV）（16%）和精神疾病（6%）。10例患者检测出的中枢性前庭病变推测为血管性或特发性起源。未发现脑肿瘤或心律失常。
前庭疾病和精神疾病是门诊患者持续性头晕最常见的病因。约一半头晕患者中，不止一个因素导致或加重症状。即使在我们的老年人群中，危及生命的病因也很罕见。
