Spiegel Rainer, Rust Heiko, Baumann Thomas, Friedrich Hergen, Sutter Raoul, Göldlin Martina, Rosin Christiane, Müri René, Mantokoudis Georgios, Bingisser Roland, Strupp Michael, Kalla Roger
Division of Internal Medicine, University Hospital, University of Basel, Switzerland / Emergency Department, University Hospital, University of Basel, Switzerland.
Department of Neurology, University Hospital, University of Basel, Switzerland.
Swiss Med Wkly. 2017 Dec 27;147:w14566. doi: 10.4414/smw.2017.14566. eCollection 2017.
This review provides an update on interdisciplinary treatment for dizziness. Dizziness can have various causes and the treatment offered should depend on the cause. After reading this article, the clinician will have an overview of current treatment recommendations. Recommendations are made for the most prevalent causes of dizziness including acute and chronic vestibular syndromes, vestibular neuritis, benign paroxysmal positional vertigo, endolymphatic hydrops and Menière’s disease, vestibular paroxysmia and vestibular migraine, cardiac causes, transient ischaemic attacks and strokes, episodic ataxia type 2, persistent postural-perceptual dizziness, bilateral vestibulopathy, degenerative, autoimmune and neoplastic diseases, upbeat- and downbeat nystagmus. Recommendations include clinical approaches (repositioning manoeuvres), medication (adding, removing or changing current medication depending on aetiology), vestibular physiotherapy, ergotherapy and rehabilitation, treatment of chest pain or stroke units and surgical interventions. If symptoms are acute and severe, medication with antivertigo agents is recommended as a first step, for a maximum period of 3 days. Following initial symptom control, treatment is tailored depending on aetiology. To assist the clinician in obtaining a useful overview, the level of evidence and number needed to treat are reported whenever possible based on study characteristics. In addition, warnings about possible arrhythmias due to medication are issued, and precautions to enable these to be avoided are discussed.
本综述提供了头晕跨学科治疗的最新情况。头晕可能有多种原因，所提供的治疗应取决于病因。阅读本文后，临床医生将对当前的治疗建议有一个全面了解。针对头晕的最常见病因给出了建议，包括急性和慢性前庭综合征、前庭神经炎、良性阵发性位置性眩晕、内淋巴积水和梅尼埃病、前庭性阵发性眩晕和前庭性偏头痛、心脏病因、短暂性脑缺血发作和中风、发作性共济失调2型、持续性姿势性感知性头晕、双侧前庭病、退行性、自身免疫性和肿瘤性疾病、上跳性和下跳性眼球震颤。建议包括临床方法（复位手法）、药物治疗（根据病因添加、停用或更换当前药物）、前庭物理治疗、职业治疗和康复、胸痛治疗或卒中单元以及手术干预。如果症状急性且严重，建议首先使用抗眩晕药物，最长使用3天。在初始症状得到控制后，根据病因进行个体化治疗。为帮助临床医生获得有用的全面了解，尽可能根据研究特征报告证据水平和治疗所需人数。此外，还发出了关于药物可能导致心律失常的警告，并讨论了避免这些情况的预防措施。
