文档介绍：BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE 眩晕( Vertigo ) ?机体或周围环境空间运动的错幻觉–旋转(最常见) –水平–垂直?平衡指定位机体及维持与周围环境空间相对关系的能力失衡:眩晕共济失调 BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE 参与平衡的解剖和生理?前庭–迷路, 前庭核半规管壶腹:角加速运动(旋转或移动) 球囊及椭圆囊:直线运动和重力?视觉– CN III, IV, VI 维持凝视?本体觉–上颈部肌肉和关节?三种感受器同时兴奋,放发冲动 BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE 参与平衡的解剖和生理? Space constancy mechanism 整合协调前庭核及通路小脑 BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE 假性眩晕?头晕不稳头沉脚轻头胀?神经症?眼肌麻痹复视?贫血?主动脉狭窄?体位性?剧咳?低血糖 BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE 头晕病人的病史询问?头晕的详细描述?鉴别眩晕和非眩晕?确定发作、时间,以及是否复发?伴随的神经系统表现和全身表现?有无听力丧失??目前用药?鉴别周围性还是中枢性 BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE 中枢性与周围性眩晕的鉴别中枢性眩晕中枢性眩晕周围性眩晕周围性眩晕眩晕的程度轻严重耳鸣少见经常伴随颅神经损害通常无视觉固定不抑制眼震抑制眼球震颤眼震旋转垂直水平单相双相水平+旋转单相潜伏期无 3-40 秒疲劳无是习服无是重复恒定可变 BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE Assessment of the dizzy patient, Australian Family Physician Vol. 31, No. 8, August 2002 周围前庭性疾患? BPPV ?迷路炎? Meniere 病?听神经瘤?运动病?颈源性?淋巴周围瘘?前庭神经元炎?半规管感染?半规管进水?外伤?酒精及药物 BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE Assessment of the dizzy patient, Australian Family Physician Vol. 31, No. 8, August 2002 中枢前庭性疾患?脑干病变?基底动脉偏头痛? TIA ?卒中? MS ?小脑病变?转移瘤?脑膜瘤 BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE 眩晕类型?主观性眩晕–病人感觉到自身旋转–急骤的牵拉感?客观性眩晕–病人自身感觉不动, 但周围的物体在动–物体的来回移动 BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE BEIJING CENTER OF ACUTE STROKE CARE 眩晕的时程眩晕持续 1天或 1天以上?前庭神经炎?迷路、脑干和小脑梗死眩晕持续数小时或数分钟? Menierer 综合征?椎基底动脉系统