头晕眩晕的鉴别及手法复位课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,头晕及眩晕的鉴别诊断,与BPPV手法复位治疗,头晕及眩晕的鉴别诊断,1,习惯性思维,椎基底动脉供血不足,VbI or Pcl,头晕,dizziness,颈椎病或颈性头(眩)晕,眩晕,Diagnose?,vertigo,梅尼埃病,前庭周围性眩晕,习惯性思维,2,存在的问题,“晕”的诸多相关概念欠清;,对头晕及眩晕很少进行认真思索;,头晕和眩晕诊断流程不明,即思路不清,检查盲目:颈椎片,头颅MRl,TcD,MRA;,治疗盲从:中医正骨,小针刀,各种汤药,输液,存在的问题,3,内容,头晕/眩晕的表现及概念,头晕/眩晕的病因分类,头晕/眩晕的常见病因及少见病因,头晕/眩晕的某些疾病的临床表现特点,头晕/眩晕的诊断流程,头晕/眩晕病例分析,关于BPPV的手位复位治疗,内容,4,头晕及眩晕的概念及表现,2009年-多伦多大学耳鼻喉科关于头晕,( dizziness)的描述:,“ t is crucial to ask patient. using words,other than dizzy, as it may carry different,meanings,Most commonly, the word is,used to describe a variety of subjective,symptoms, including vertigo, unsteadiness,light-headedness, generalized weakness,presyncope, syncope, or falling,Chan Y Differential diagnosis of dizziness. Curr Opin,otolaryngol Head Neck Surg. 2009 17: 200-203,头晕及眩晕的概念及表现,5,头晕及眩晕的概念及表现,“头晕”的相关概念,头昏,头狭义非眩头翠好,晕厥前状态,广义地说头晕包括各种”,晕厥,晕”的概念狭义而言头,不稳或失平衡感晕不包含眩晕,头晕及眩晕的概念及表现,6,一.头晕/眩晕的概念及表现,头晕狭,眩晕,头昏,头沉,运动错觉,大脑不清晰感,睡眠障碍,旋转感:翻江倒海,摇摆不稳,头胀,食欲改变,波浪起伏,头重脚轻,心血管症状,消化道症状,下落感,无旋转感,恶心,不敢睁眼,不稳感,呕吐,眼震,100%均有体验,共济失调,可伴定位体征,一.头晕/眩晕的概念及表现,7,头晕/眩晕的分类,非前庭系统性眩晕,前庭系统眩晕,内科系统病:心血管疾病(血压高低,周围性,心率失常);血液疾病;内分泌疾病,良性发作性位置性眩晕,环境及活动:高温,中著久立过劳等美尼埃病,癲痫:复杂部分性发作,前庭神经元炎,晕厥(前状态),迷路炎、淋巴管漏,头外伤后综合征,中枢性,视觉性:眼肌麻痹(痛性、MG等),后循环缺血或VB,深感觉障碍:亚急性联合变性等,脑梗塞/脑出血,精神性:抑郁焦虑状态,脑肿瘤,脑炎或脱髓鞘病,混合性,偏头痛眩晕(等位症),药物影响或药物中毒,头晕/眩晕的分类,8,三头晕及眩晕的常见病因及少见病因,口头晕及眩晕的常见原因,良性发作性位置性眩晕(BPPV),偏头痛性眩晕或头晕(偏头痛等位症),精神源性头晕或眩晕:焦虑抑郁状态,非前庭系统性眩晕(血压/药物影响/内科疾病),椎基底动脉系统TA10%,三头晕及眩晕的常见病因及少见病因,9,神经科头晕门诊200例患者的病因分析,NEUROLOGY 2001: 56: 436,table 2 Diagnoses in 200 patients woith and without migraine presenting to a neurologic dizziness clinic,Dizziness,Dizziness cmic,Dizziness clinie patien,Diagnos,in=200,Benign paroxysmal positional vertigo,6l31,21(2),40(32),Psychogenic dizzinEss,12(16),28(22,1:1,Vestibulopathy of unknown origin,14(T,9(7,Neurologic gait disarm,1,(3,Probable,vertigo,Central vestibular syndromes,Vestibular peurhs,Other diagnoses,Undetermined,5(,神经科头晕门诊200例患者的病因分析,10,头晕眩晕的鉴别及手法复位课件,11,头晕眩晕的鉴别及手法复位课件,12,头晕眩晕的鉴别及手法复位课件,13,头晕眩晕的鉴别及手法复位课件,14,头晕眩晕的鉴别及手法复位课件,15,头晕眩晕的鉴别及手法复位课件,16,头晕眩晕的鉴别及手法复位课件,17,头晕眩晕的鉴别及手法复位课件,18,头晕眩晕的鉴别及手法复位课件,19,头晕眩晕的鉴别及手法复位课件,20,头晕眩晕的鉴别及手法复位课件,21,头晕眩晕的鉴别及手法复位课件,22,头晕眩晕的鉴别及手法复位课件,23,头晕眩晕的鉴别及手法复位课件,24,头晕眩晕的鉴别及手法复位课件,25,头晕眩晕的鉴别及手法复位课件,26,头晕眩晕的鉴别及手法复位课件,27,头晕眩晕的鉴别及手法复位课件,28,头晕眩晕的鉴别及手法复位课件,29,头晕眩晕的鉴别及手法复位课件,30,头晕眩晕的鉴别及手法复位课件,31,头晕眩晕的鉴别及手法复位课件,32,头晕眩晕的鉴别及手法复位课件,33,头晕眩晕的鉴别及手法复位课件,34,头晕眩晕的鉴别及手法复位课件,35,头晕眩晕的鉴别及手法复位课件,36,头晕眩晕的鉴别及手法复位课件,37,头晕眩晕的鉴别及手法复位课件,38,头晕眩晕的鉴别及手法复位课件,39,头晕眩晕的鉴别及手法复位课件,40,头晕眩晕的鉴别及手法复位课件,41,头晕眩晕的鉴别及手法复位课件,42,头晕眩晕的鉴别及手法复位课件,43,头晕眩晕的鉴别及手法复位课件,44,头晕眩晕的鉴别及手法复位课件,45,头晕眩晕的鉴别及手法复位课件,46,头晕眩晕的鉴别及手法复位课件,47,头晕眩晕的鉴别及手法复位课件,48,头晕眩晕的鉴别及手法复位课件,49,头晕眩晕的鉴别及手法复位课件,50,头晕眩晕的鉴别及手法复位课件,51,头晕眩晕的鉴别及手法复位课件,52,头晕眩晕的鉴别及手法复位课件,53,头晕眩晕的鉴别及手法复位课件,54,