Muncie Herbert L, Sirmans Susan M, James Ernest
Louisiana State University School of Medicine, New Orleans, LA, USA.
University of Louisiana at Monroe School of Pharmacy, Monroe, LA, USA.
Am Fam Physician. 2017 Feb 1;95(3):154-162.
Dizziness is a common yet imprecise symptom. It was traditionally divided into four categories based on the patient's history: vertigo, presyncope, disequilibrium, and light-headedness. However, the distinction between these symptoms is of limited clinical usefulness. Patients have difficulty describing the quality of their symptoms but can more consistently identify the timing and triggers. Episodic vertigo triggered by head motion may be due to benign paroxysmal positional vertigo. Vertigo with unilateral hearing loss suggests Meniere disease. Episodic vertigo not associated with any trigger may be a symptom of vestibular neuritis. Evaluation focuses on determining whether the etiology is peripheral or central. Peripheral etiologies are usually benign. Central etiologies often require urgent treatment. The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies. The physical examination includes orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, and the Dix-Hallpike maneuver. Laboratory testing and imaging are not required and are usually not helpful. Benign paroxysmal positional vertigo can be treated with a canalith repositioning procedure (e.g., Epley maneuver). Treatment of Meniere disease includes salt restriction and diuretics. Symptoms of vestibular neuritis are relieved with vestibular suppressant medications and vestibular rehabilitation.
头晕是一种常见但不确切的症状。传统上，根据患者的病史将其分为四类：眩晕、晕厥前状态、平衡失调和头晕。然而，这些症状之间的区别在临床上的用途有限。患者难以描述其症状的性质，但能更一致地确定症状出现的时间和诱因。由头部运动引发的发作性眩晕可能是良性阵发性位置性眩晕。伴有单侧听力丧失的眩晕提示梅尼埃病。与任何诱因无关的发作性眩晕可能是前庭神经炎的症状。评估重点在于确定病因是外周性还是中枢性。外周性病因通常是良性的。中枢性病因往往需要紧急治疗。HINTS（头部脉冲、眼球震颤、斜视试验）检查有助于区分外周性和中枢性病因。体格检查包括测量直立位血压、全面的心脏和神经系统检查、评估眼球震颤以及进行 Dix-Hallpike 手法检查。通常不需要实验室检查和影像学检查，而且它们往往也没有帮助。良性阵发性位置性眩晕可用耳石复位程序（如 Epley 手法）进行治疗。梅尼埃病的治疗包括限盐和使用利尿剂。前庭神经炎的症状可通过前庭抑制药物和前庭康复得到缓解。
