Journal of Medicine and Life Science

  • 제16권3호
  • /
  • Pages.64-75
  • /
  • 2019
  • /
  • 1738-1010(pISSN)
  • /
  • 2671-4922(eISSN)
제주대학교 의과학연구소 (Institute for Medical Science)
권호 표지
DOI QR코드

DOI QR Code

어지럼증의 감별진단

Differential diagnosis of vertigo

  • 강지훈 (제주대학교 의과대학 신경과) ;
  • 신지용 (제주대학교병원 신경과) ;
  • 김민주 (제주대학교병원 신경과) ;
  • 마효일 (한림대학교 의과대학 신경과)
  • Kang, Ji-Hoon (Department of Neurology, Jeju National University College of Medicine) ;
  • Shin, Ji-Yong (Department of Neurology, Jeju National University Hospital) ;
  • Kim, Min-Ju (Department of Neurology, Jeju National University Hospital) ;
  • Ma, Hyeo-Il (Department of Neurology, Hallym University College of Medicine)
  • 투고 : 2019.10.23
  • 심사 : 2019.11.06
  • 발행 : 2019.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Vertigo and dizziness are common symptoms with various etiologies and pathogeneses. Vertigo is an illusion of motion due to disease of the vestibular system, usually a sense of rotation. Dizziness, a term that represents a wide range of non-vertigo symptoms, is commonly associated with non-vestibular disorders including old age, cardiac syncope, orthostatic hypotension, metabolic disease, anxiety, and drugs. Vertigo should be determined whether the cause is central or peripheral. Peripheral vertigo is usually benign but central vertigo is serious and often require urgent treatment. The careful history and detailed physical examinations(pattern of nystagmus, ocular tilt reaction, head impulse test and positional tests such as Dix-Hallpike maneuver) provide important clues to the diagnosis of vertigo. Most of patients have benign peripheral vestibular disorders - vestibular neuritis, benign paroxysmal positional vertigo (BPPV), and Meniere's disease. BPPV is a leading cause of peripheral vertigo and can easily be cured with a canalith repositioning maneuver. In this review, a focus is on the differential diagnosis of common vestibular disorders with peripheral and central causes.

키워드

참고문헌

  1. Brandt T. Vertigo: Its multisensory syndromes. 1999. Springer-Verlag, London.
  2. Baloh RW, Honrubia V. Clinical neurophysiology of the vestibular system. 1989. FA Davis. Philadelphia.
  3. Bisdorff A, Von Brevern M, Lempert T, Newman-Toker DE. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res 2009;19:1-13. https://doi.org/10.3233/VES-2009-0343
  4. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011;21:69-72. https://doi.org/10.1007/s10286-011-0119-5
  5. Halmagyi GM, Curthoys IS. A clinical sign of canal paresis. Arch Neurol 1988;45:737-9. https://doi.org/10.1001/archneur.1988.00520310043015
  6. Brandt T, Dieterich M. Vestibular syndrome in the roll plane: Topographic diagnosis from brainstem to cortex. Ann Neurol 1994;36:337-47. https://doi.org/10.1002/ana.410360304
  7. Hotson JR, Baloh RW. Acute vestibular syndrome. NEJM 1998;339:680-5. https://doi.org/10.1056/NEJM199809033391007
  8. Baloh RW. Dizziness, hearing loss, and tinnitus. 1998. FA Davis. Philadelphia.
  9. Kim JS. Stroke and ocular motor dysfunction. Korean Journal of Stroke 1999;1:126-38.
  10. Amarenco P, Hauw JJ. Cerebellar infarction in the territory of the anterior and inferior cerebellar artery. A clinicopathological study of 20 cases. Brain 1990;113:139-55. https://doi.org/10.1093/brain/113.1.139
  11. Lee H, Cho YW. A case of isolated nodulus infarction presenting as a vestibular neuritis. J Neurol Sci 2004;221:117-9. https://doi.org/10.1016/j.jns.2004.03.022
  12. Lee TK. Central positional vertigo. Res Vestibul Sci 2011;10:19-23.
  13. Epley JM. Positional vertigo related to semicircular canalithiasis. Otolaryngol Head Neck Surg 1995;112:154-61. https://doi.org/10.1016/S0194-5998(95)70315-2
  14. Schuknecht HF. Cupulolithiasis. Arch Otolaryngol 1969;90:765-78. https://doi.org/10.1001/archotol.1969.00770030767020
  15. Dix R, Hallpike CS. The pathology, symptomatology, and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med 1952;54:341-54.
  16. Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992;107:399-404. https://doi.org/10.1177/019459989210700310
  17. Baloh RW, Jacobson K, Honrubia V. Horizontal semicircular canal variant of benign positional vertigo. Neurology 1993;43:2542-9. https://doi.org/10.1212/WNL.43.12.2542
  18. Baloh RW, Yue Q, Jacobson KM, Honrubia V. Persistent direction-changing postional nystagmus: Another variant of benign positional nystagmus? Neurology 1995;45:1297-301. https://doi.org/10.1212/WNL.45.7.1297
  19. Han BI, Oh HJ, Kim JS. Nystagmus while recumbent in horizontal canal benign paroxysmal positional vertigo. Neurology 2006;66:706-10. https://doi.org/10.1212/01.wnl.0000201184.69134.23
  20. Lee SH, Choi KD, Jeong SH, Oh YM, Koo JW, Kim JS. Nystagmus during neck flexion in the pitch plane in benign paroxysmal positional vertigo involving the horizontal canal. J Neurol Sci 2007;256:75-80. https://doi.org/10.1016/j.jns.2007.02.026
  21. Kim JS, Zee DS. Clinical practice. Benign paroxysmal positional vertigo. NEJM 2014;370:1138-47. https://doi.org/10.1056/NEJMcp1309481
  22. Vannucchi P, Giannoni B, Pagnini P. Treatment of horizontal semicircular canal benign paroxysmal positional vertigo. J Vestib Res 1997;7:1-6.
  23. Gufoni M, Mastrosimone L, Di Nasso F. [Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal]. Acta Otorhinolaryngol Ital 1998;18:363-7.
  24. Yacovino DA, Hain TC, Gualtieri F. New therapeutic maneuver for anterior canal benign paroxysmal positional vertigo. J Neurol 2009;256:1851-5. https://doi.org/10.1007/s00415-009-5208-1

피인용 문헌

  1. EFFECT TO PROMOTION ACTIVITIES OF DISASTER PREVENTION AND MITIGATION INCORPORATED IN LIFESTYLE BASED ON COMMUNITY DISASTER MANAGEMENT PLAN vol.76, pp.2, 2020, https://doi.org/10.2208/jscejsp.76.2_i_141