Staab Jeffrey P, Ruckenstein Michael J
Department of Psychiatry, The Balance Center, University of Pennsylvania Health System, Philadelphia, PA, USA.
Arch Otolaryngol Head Neck Surg. 2007 Feb;133(2):170-6. doi: 10.1001/archotol.133.2.170.
To improve treatment outcomes for patients with chronic dizziness by identifying clinical conditions associated with persistent symptoms and delineating key diagnostic features that differentiate its causes and direct attention to specific treatments.
Prospective cohort study from 1998 to 2004.
Tertiary care balance center.
A total of 345 men and women, aged 15 to 89 years, referred for evaluation of chronic dizziness (duration of > or =3 months) of uncertain cause.
Patients were systematically directed through multiple specialty examinations until definitive diagnoses were made.
Final diagnoses associated with dizziness.
Nearly all patients with chronic subjective dizziness were diagnosed with psychiatric or neurologic illnesses. These included primary and secondary anxiety disorders (n = 206 [59.7%]) and central nervous system conditions (n = 133 [38.6%]), specifically migraine headaches, mild traumatic brain injuries, and neurally mediated dysautonomias. A small number of patients (6 [1.7%]) had dysrhythmias. Four of 5 patients with migraine or dysrhythmias had comorbid anxiety.
Chronic dizziness has several common causes, including anxiety disorders, migraine, traumatic brain injuries, and dysautonomia, that require different treatments. Key features of the clinical history distinguish these illnesses from one another and from active neurotologic conditions. The high prevalence of secondary anxiety may give a false impression of psychogenicity.
通过识别与持续性症状相关的临床状况，勾勒出区分其病因的关键诊断特征，并将注意力引向特定治疗方法，以改善慢性头晕患者的治疗效果。
1998年至2004年的前瞻性队列研究。
三级医疗平衡中心。
共有345名年龄在15至89岁之间的男女，因病因不明的慢性头晕（持续时间≥3个月）前来接受评估。
系统地指导患者接受多项专科检查，直至做出明确诊断。
与头晕相关的最终诊断。
几乎所有慢性主观性头晕患者均被诊断患有精神或神经疾病。这些疾病包括原发性和继发性焦虑症（n = 206 [59.7%]）和中枢神经系统疾病（n = 133 [38.6%]），具体为偏头痛、轻度创伤性脑损伤和神经介导的自主神经功能障碍。少数患者（6 [1.7%]）患有心律失常。5名偏头痛或心律失常患者中有4名合并焦虑症。
慢性头晕有多种常见病因，包括焦虑症、偏头痛、创伤性脑损伤和自主神经功能障碍，需要不同的治疗方法。临床病史的关键特征可将这些疾病相互区分，并与活动性耳科疾病区分开来。继发性焦虑的高患病率可能会给人造成心因性的错误印象。
