Magnusson M, Malmström E-M
Department of Otorhinolaryngology, Lund University, Skane University Hospital, Lund, Sweden.
Department of Otorhinolaryngology, Lund University, Skane University Hospital, Lund, Sweden; Department of Pain Rehabilitation, Lund University, Skane University Hospital, Lund, Sweden.
Handb Clin Neurol. 2016;137:365-9. doi: 10.1016/B978-0-444-63437-5.00026-1.
Cervicogenic or cervical dizziness is debated as an entity. However, there exists both a physiologic basis and a multitude of clinical data to make such a disease concept at least possible and worth considering. In addition, the interaction of proprioceptive and vestibular mechanisms may amplify dizziness of other origin. Cervical pain and dizziness are both common symptoms and may coincide, and neck pain or obvious dysfunction does not necessarily cause dizziness or balance disturbances. So far, there is also the lack of a proper diagnostic test for cervicogenic dizziness. On the other hand, there is growing evidence that cervical proprioceptive input is important for balance and postural control not only in animals but also in humans, and that intervention in disorders affecting the human cervical segment may relieve dizziness in some patients. It is advocated that the diagnosis should be used with care and that there is a need for better diagnostic tests. In the absence of such a test, one has to rely on preliminary criteria and a diagnosis ex juvantibus. A possible approach would require patients to present with neck pain before or in close temporal relation with dizziness; that other causes should be made at least unlikely; and that treatment of a cervical dysfunction reduces also dizziness or balance disturbance.
颈源性头晕作为一个独立的病症存在争议。然而，有生理学依据和大量临床数据表明，这样一种疾病概念至少是有可能存在且值得考虑的。此外，本体感觉和前庭机制的相互作用可能会加重其他原因引起的头晕。颈部疼痛和头晕都是常见症状，可能同时出现，但颈部疼痛或明显功能障碍不一定会导致头晕或平衡失调。到目前为止，也缺乏针对颈源性头晕的合适诊断测试。另一方面，越来越多的证据表明，颈部本体感觉输入不仅对动物，而且对人类的平衡和姿势控制都很重要，并且对影响人类颈椎节段的疾病进行干预可能会使一些患者的头晕症状得到缓解。有人主张应谨慎使用该诊断，并且需要更好的诊断测试。在没有这种测试的情况下，人们不得不依靠初步标准和试验性诊断。一种可能的方法是要求患者在头晕之前或与头晕在时间上密切相关时出现颈部疼痛；其他原因至少应不太可能；并且治疗颈椎功能障碍也能减轻头晕或平衡失调。
