Dodt C, Zelihic E
Notfallzentrum, Städtisches Klinikum München Bogenhausen, Englschalkinger Strasse 77, Munich, Germany.
Med Klin Intensivmed Notfmed. 2013 Feb;108(1):41-6. doi: 10.1007/s00063-012-0173-3. Epub 2013 Feb 3.
Vertigo and dizziness are common symptoms in the acute care setting and have a wide diagnostic range. The most deleterious diagnosis is vertebrobasilar disease with brain infarction in the posterior fossa. Therefore, every patient with acute vestibular syndrome needs to be evaluated by a structured interview and a systematic physical examination for red flag symptoms which indicate vertebrobasilar infarction. Routinely, the physical examination should cover the head impulse (Halmagyi) test, test for nystagmus as well as the test of skew and in cases of benign paroxysmal positional vertigo, by the Dix-Hallpike maneuver. The suspicion of a central cause of vertigo is ideally confirmed by a magnetic resonance imaging (MRI) scan. Most patients with a peripheral cause of vertigo can be discharged under symptomatic therapy with the advice to consult an ear nose and throat physician while patients with a central cause of vertigo are admitted for further neurological treatment.
眩晕和头晕是急性护理环境中的常见症状，诊断范围广泛。最严重的诊断是后颅窝脑梗死的椎基底动脉疾病。因此，每位急性前庭综合征患者都需要通过结构化访谈和系统的体格检查来评估是否存在提示椎基底动脉梗死的警示症状。常规的体格检查应包括头部脉冲（Halmagyi）试验、眼球震颤试验以及斜视试验，对于良性阵发性位置性眩晕患者，还应进行Dix-Hallpike手法检查。眩晕的中枢性病因怀疑最好通过磁共振成像（MRI）扫描来确诊。大多数外周性眩晕病因的患者在对症治疗后可出院，并建议咨询耳鼻喉科医生，而中枢性眩晕病因的患者则需住院接受进一步的神经治疗。
