眩暈的診斷與鑒別ppt課件(參考版)
2025-01-18 21:23本頁面
【正文】 ?病因治療： 針對(duì)診斷明確的疾病做相應(yīng)的治療。 Hallpike manoeuvre 位置性眩暈誘發(fā)試驗(yàn) 頭暈及眩暈的防治 眩暈有各種各樣的原因，若眩暈伴有聽力或局灶性神經(jīng)系統(tǒng)癥狀和體征容易診斷，但是臨床病人常常只表現(xiàn)單純性的眩暈，有時(shí)做了各種輔助檢查，診斷還是無法確診，最后只是對(duì)癥治療。然后頭轉(zhuǎn)向另一側(cè)，并 重復(fù)上述試驗(yàn)。囑咐病人睜眼，如果出現(xiàn)眼震，即維持頭位于該位置 30秒種，記 錄眼球震顫的方向、節(jié)律、持續(xù)時(shí)間。良性位置性眩暈常 可自限性，但也可有反復(fù)發(fā)作幾年，耳操 （ BrandtDaroff exercises)可使耳石的沉查碎裂或移動(dòng) 到其他迷路部位從而緩解眩暈。 62: 245252. A 21yearold male presented with left side facial palsy of 20 day’s duration. He had hearing loss and vertigo suddenly developed, following by facial palsy. MRI showed a small , 1 x 2cm, wellenhanced mass in the left internal auditory canal, originating from the facial nerve . 良性位置性眩暈 占周圍性眩暈就診病人的 25%，病因?yàn)閬碓从跈E圓囊 耳石，任何年齡均可發(fā)生，老年人多見，在一定頭位 上出現(xiàn)一過性眩暈、眼震。 9: 328333. The most mon clinical presentation of patients with bilateral superior cerebellar artery (SCA) infarctions were nausea, vomiting, or vertigo, often associated with ataxia and dysarthria. Complete infarction of the SCA territory on the right, partialinfarcton left, and pontine infarction Scattered bilateral infarcts Scattered infarcts Facial nerve schwannomas Surg Neurol 2022。24(6):420425. Right cerevellopontine angle arachnoid cyst Right cystoperitoneal shunt showing decrease in size of arachnoid cyst A 52yearold woman presented with 18year history of feeling as if she were on “the deck of a ship”. She had recently developed episodic rightsided aural fullness, tinnitus, and associated whirling vertigo with nausea and emesis. She had previously been diagnosed with rightsided Meniere’s disease. MRI scan revealed a right cerebellopontine angle arachnoid cyst inferior to the internal auditory canal with mild mass effect. The patient had several neurosurgical opinions. A few of the consultants expressed the opinion that the arachnoid cyst was not related to her inner ear symptoms. She elected to undergo a right cystoperitoneal shunt. She then developed plete relief of her rightsided tinnitus and aural fullness. She has not any further episodes of vertigo. Vertebral artery dissection 椎動(dòng)脈夾層動(dòng)脈瘤 。耳石 功能檢查常有異常。橢圓囊、球囊耳石病變。積水的病理變化刺激及損傷耳蝸產(chǎn)生耳鳴、耳聾；刺激前庭終器即可出現(xiàn)眩暈、眼球震顫、平衡失調(diào)、以及惡性、嘔吐、心律變慢、血壓下降、面色蒼白等植物神經(jīng)癥狀。 真正的病因未明。 ?通過相關(guān)檢查出外其他病因。 ? 通過相關(guān)檢查出外其他病因 疑診偏頭痛性眩暈 ?至少中度嚴(yán)重性的發(fā)作性前庭癥狀（旋轉(zhuǎn)性眩暈、自身和周圍物體幻動(dòng)、不能耐受頭部運(yùn)動(dòng)）。 ? 按照國(guó)際頭痛學(xué)會(huì) (HIS)標(biāo)準(zhǔn)符合偏頭痛。 ，這樣患耳向上，30秒 病人轉(zhuǎn)向一側(cè)，頭看地板， 30秒 病人坐起 重復(fù)，直至不再出現(xiàn)
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