Department of ENT, Tuen Mun Hospital, Tuen Mun, Hong Kong.
Hong Kong Med J. 2012 Aug;18(4):327-32.
Dizziness is among the commonest of chief complaints. It often presents a significant challenge to the attending physician, because the symptoms and signs are often vague and non-specific. However, a robust systematic approach can usually arrive at the diagnosis. Maintaining balance requires sensory inputs from the vestibular, visual, and somatosensory systems and the cerebellum fine-tunes inaccurate motor outputs. Causes of vertigo are most commonly otological, followed by central, somatosensory, and visual. The first question in approaching patients with dizziness is to categorise dizziness into one of the four groups: lightheadedness, pre-syncope, disequilibrium, and vertigo. Secondly, central vertigo has to be differentiated with peripheral vertigo. For peripheral vertigo, the most common cause is benign paroxysmal positional vertigo and should be specifically looked for. The tempo of the vertiginous attacks and other associated symptoms can help differentiate the other causes of peripheral vertigo, including Meniere's disease, vestibular neuronitis, labyrinthitis, and a perilymph fistula.
头晕是最常见的主诉之一。它常常给主治医生带来很大的挑战，因为症状和体征往往是模糊和非特异性的。然而，一个健全的系统方法通常可以得出诊断。保持平衡需要来自前庭、视觉和躯体感觉系统的感觉输入，小脑则对不准确的运动输出进行微调。眩晕的原因最常见的是耳科疾病，其次是中枢、躯体感觉和视觉。在处理头晕患者时，首先要将头晕分为以下四类之一：头晕、晕厥前、失衡和眩晕。其次，必须区分中枢性眩晕和周围性眩晕。对于周围性眩晕，最常见的原因是良性阵发性位置性眩晕，应特别寻找。眩晕发作的节奏和其他相关症状有助于区分周围性眩晕的其他原因，包括梅尼埃病、前庭神经炎、迷路炎和内淋巴瘘。
