Feuerecker Regina, Habs Maximilian, Dieterich Marianne, Strupp Michael
Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany.
Center of Systems Neurology, SyNergy, University of Munich, Munich, Germany.
J Vestib Res. 2015;25(2):67-72. doi: 10.3233/VES-150547.
Chronic subjective dizziness (CSD) is a form of chronic dizziness. Many patients report fewer symptoms when they get up with an aggravation over of the day. Therefore, the change in the severity of the symptoms during daytime was evaluated and compared with other chronic vestibular diseases: bilateral vestibulopathy (BVP) and downbeat nystagmus (DBN).
DESIGN/METHODS: In a prospective study 131 patients with CSD, 108 patients with BVP, and 38 patients with DBN filled out a questionnaire asking about the symptom intensity (0 = no symptoms, 1 = light, 2 = moderate, 3 = strong) at 6 time-points. The influences of duration of the disease and physical activity on the change of symptoms were also investigated.
The symptom intensity score in CSD was lower after getting up in comparison to later time points. In BVP a strong sensation of dizziness after getting up with worsening in the evening was observed. In DBN symptoms significantly improved during daytime. In BVP, the symptom intensity scores were significantly higher in patients with symptoms more than six month as less than six month. In the other groups, no association between duration of illness and intensity of perceived dizziness could be seen.
There are considerable differences in the change in symptoms between the three diseases. Taking the patient history simply asking how the symptoms are when the patient gets up in the morning and how they change during daytime can be helpful in the differential diagnosis. Having less or no symptoms after getting up may be a diagnostic criterion for CSD.
慢性主观性头晕（CSD）是慢性头晕的一种形式。许多患者报告称起床时症状较少，而一天中症状会加重。因此，评估了白天症状严重程度的变化，并与其他慢性前庭疾病进行比较：双侧前庭病（BVP）和下跳性眼球震颤（DBN）。
设计/方法：在一项前瞻性研究中，131例CSD患者、108例BVP患者和38例DBN患者填写了一份问卷，询问6个时间点的症状强度（0 = 无症状，1 = 轻度，2 = 中度，3 = 重度）。还研究了疾病持续时间和体力活动对症状变化的影响。
与之后的时间点相比，CSD患者起床后的症状强度评分较低。在BVP患者中，起床后有强烈的头晕感，晚上症状加重。在DBN患者中，白天症状明显改善。在BVP患者中，症状持续超过6个月的患者的症状强度评分显著高于症状持续不到6个月的患者。在其他组中，未发现疾病持续时间与感知到的头晕强度之间存在关联。
这三种疾病在症状变化方面存在显著差异。仅通过询问患者病史，了解患者早上起床时的症状以及白天症状如何变化，可能有助于进行鉴别诊断。起床后症状较少或无症状可能是CSD的一个诊断标准。
