心因性頭暈的診斷治療課件

心因性頭暈的診斷治療心因性頭暈的診斷治療1心因性頭暈的診斷治療DiagnosisandTreatmentofPsychogenicDizziness2019-05-09心因性頭暈的診斷治療2內(nèi)容概要一、頭暈的概念及癥候、心因性頭暈的發(fā)生率三、心因性頭暈的臨床表現(xiàn)四、心因性頭暈的發(fā)病因素五、心因性頭暈的治療六、心因性頭暈的鑒別診斷七、心因性頭暈的表現(xiàn)舉例2020/5/4海軍總醫(yī)院神內(nèi)容概要3、頭暈的概念及癥候Dizziness:ADiagnosticApproachROBERTEPOST,MD,VirtuaFarmilyMedicineResidencyVoorhees,NewJeLORIM.DICKERSON,PharmD,MedicalUniversityofSouthCarolina,Charleston,SouthCarolinaDizzinessaccountsforanestimated5percentofprimarycareclinicvisits.Thepatienthistorycangenerallyclassifdizzinessintooneoffourcategories:vertigoorlightheadedness,Themaincausesofvertigoarebenignparoxysmalpositionalvertigo,Meniease,vestibuletisandlabyrinthitis.Manymedicationscancausepresyncope,andregimensshouldbeassessedinpatientswiththistypeofdizziness,Parkinsondiseaseanddiabeticneuropathyshouldbeconsideredwiththediagnosisofdisequilibrium.Psychiatricdisorders,suchasdepression,anxiety,andhyperventilationsyndrome,cancausevaguelightheadedness.Thedifferentialdiagnosisofdizzinesscanbenarowedwitheasy-to-performphysicalexaminationtests,includingevaluationfornystagmus,theDix-Hallpikemaneuver,andortho-staticbloodpressuretesting.Laboratorytestingandradiographyplaylittleroleindiagnosis.Afinaldiagnosisisnotobtainedinabout0percentofcases.TreatmentofvertigoincludestheEpleymaneu-ver(canalithrepositioning)andvestibularrehabilitationforbenignparoxysmalpositionalvertigo,intratympanicdexamethasoneorgentamicinforMenieredisease,andsteroidsforvestibularneuritis.Orthostatichypotensionthatcausespreynopecanbetreatedwithalphaagonists,mineralocorticoids,orlifestylechanges.Disequilib-riumandlightheadednesscanbealleviatedbytreatingtheunderlyngcause(AmFanPhysician.2010;82(4):361-368.Copyright2010AmericanAcademyofFamilyPhysicians.y、頭暈的概念及癥候4頭暈的概念及癥候“頭暈[dizziness]”的概念分類頭昏[ghtheadedness]:頭沉,大腦不清晰感眩暈[vertigo]:運(yùn)動(dòng)錯(cuò)覺(視覺及主觀感覺旋轉(zhuǎn))暈厥前狀態(tài)[presyncope]:暈,眼前發(fā)黑,心慌失衡[disequilibrium:不穩(wěn)感。一海軍總醫(yī)院神頭暈的概念及癥候5、頭暈的概念及癥候Table1.MainCategoriesofDizzinessPercentagepatiantscategoryDascnDNonwithdizzinessvertIcFalsesenseofmotion45to54possiblyspinningsensatioDIsequilibriumoff-balanceorwobblyupto16PresyncopeFeelIngoflosingconsdoLnessorLightheadednessvaguesymptomsApproxlmatelypossiblyfeelIngdiconnectedwlththeenvIronmentInformationfromreferences4.5.4and8、頭暈的概念及癥候6頭暈/眩暈的概念及癥候Table3.SelectedCausesofDizzinesscategoryMagnesiccenaBenignparoxysmalvertIgoLooseotolithinsemldrauarcanalscausingPosltlvefindIngswithDIx-Haafalsesansaofmotionmaneuver,epodevertiHyperventIlationghtheadednes,Hyperventilationcausingresplratoryalkalosis;SymptomsreproducedwlthvoluntaryunderlyinganxetymayprovokethehyperventillatlonMenieredseasevertigoIncreasedendlymphatkfluidintheInnerearEpisodicvertionwIthhearinglossMigrainousvertigohypothesislsthattrigeminalnucleistimulationcausesnystagmusduringatleasttwoepisodesofvertiOrthostatetopInbloodpressureonposltiondangeSystolicbloodpressuredecreaseof20mmhypotensionusingdecreasedbloodfiowtothebrain,Ho,dlastolicbloodpressuredeceasedverseeffectofmultiplemedicationsof10mmH,orapubeincreaseofiseeTable2)3obeatspermInuteParkinsondeaseisequllbriumDysfunctioningaitcausingimbalancewinaandpossiblePeripheralneuropathyDlsequllbriumDecreasedtactileresponsewhenwalkingDecreasedsenslowerextremities,touchhegroundeadingtombalanceMnformationromeferences4,7,B,and13through20.頭暈/眩暈的概念及癥候7心因性頭暈的發(fā)生率神經(jīng)科頭暈門診200例患者的病因分析NEUROLOGY2019:56436Table2Diagosesin200patientswithandwithoutmigrainepresentingfoaneurologicdumainesclinicDizzinessdiniepatientschmegrouppatientswithmigrainewithoutmigraineia=125)Benignparoxysmalpositionalvertige61(31)21t2540(32DetinitemigrainousvertigO1419Vestibulopathyafunknownorgin心因性頭暈占到20%,其中有偏頭痛史的心因性叫頭暈占6%,無偏頭痛史占14%Vestibularneuritis6{5心因性頭暈的發(fā)生率8、心因性頭暈的發(fā)生率Brandt20195353例神經(jīng)科頭暈門診患者的病因分析TABLE1TheFrequencyofDifferentvertigo/DizzinesSyndromesin5353PatientsSeeninaNeurologicalDizzinessUnitDiagnosisPercentage(%oBenignparoxysmalItionalvertigo99之18.5699Vestibularmigraine55310.3Meniere'sdisease4448.3Vestibularneuritis40teralvestibulopatVestibularparoxysmic173Perilymphfistula0.4Unknownvertigosyndromes214Otherdisorders630l1.8、心因性頭暈的發(fā)生率9回msP加w某m4)80JournalofPsychosomaticResearchELSEVIERShortcommunicationAnxious,introvertedpersonalitytraitsinpatientswithchronicsubjectivedizzinessJeffreyPStaab*,DanielE.RoheScottD.Z.Eggers,NeilTShepards種如山D可知。M《tMNARTICLEINFOABSTRACTwbcschroksDciedizzinessISD)isaneurutkgidisorderadpersistentnot-ermiginaisdainesA中會(huì)d9Mrbe2013ronucdDnetMethdsDatawervabtuctedrwueapwctiwlytromdialrwardaf40patentwladcnaandironsaherthanCSDplusco-exisnnganxeryaespenalitytraitsleafedwattleNEDPeisonirynventary-Revied(NEO-R).andtemperamentsarHATX-adetyseurDSMIwwnthnrexciteerletempetmentsstmglyasdatelwiCsDandmayheaniskadnrluropingsyndronec2013HeverincAllrightsreserved.回msP加w某m4)8010failuretoreturntonormalposturalcontrolafteradaptingtothedemandsofacutevestibularcrises11CSDisnotarareornewconditionitisthesecondmostcommoncauseofdizzinessintertiaryneurotologycentersthattrackit1.Phys-icalsymptomsofCSDaresimilartothoseofphobicposturalvertigo(PPV),whichwasdescribedinGermany27yearsago6].However,thedefinitionofPPvincludedmildanxietyanddepressivesymptomsandobsessivecompulsivepersonalitytraits6thatwerenotretainedinthedefinitionofCSD.Thisconceptualrefinementparallelschangesinconstructsofirritablebowelsyndrome(IBs)fromearlypsychos-maticformulationsthatincludedanxietyanddepressivesymptoms,StaabJP,etal.JPsychosomaticRes,2019,76:80-832020/5/4海軍總醫(yī)院神經(jīng)內(nèi)科failuretoreturntonormalpo11心因性頭暈的診斷治療課件12心因性頭暈的診斷治療課件13心因性頭暈的診斷治療課件14心因性頭暈的診斷治療課件15心因性頭暈的診斷治療課件16心因性頭暈的診斷治療課件17心因性頭暈的診斷治療課件18心因性頭暈的診斷治療課件19心因性頭暈的診斷治療課件20心因性頭暈的診斷治療課件21心因性頭暈的診斷治療課件22心因性頭暈的診斷治療課件23心因性頭暈的診斷治療課件24心因性頭暈的診斷治療課件25心因性頭暈的診斷治療課件26心因性頭暈的診斷治療課件27心因性頭暈的診斷治療課件28心因性頭暈的診斷治療課件29心因性頭暈的診斷治療課件30心因性頭暈的診斷治療課件31心因性頭暈的診斷治療課件32心因性頭暈的診斷治療課件33心因性頭暈的診斷治療課件34心因性頭暈的診斷治療課件35心因性頭暈的診斷治療課件36心因性頭暈的診斷治療課件37心因性頭暈的診斷治療課件38心因性頭暈的診斷治療課件39心因性頭暈的診斷治療課件40心因性頭暈的診斷治療課件41心因性頭暈的診斷治療課件42心因性頭暈的診斷治療課件43心因性頭暈的診斷治療課件44心因性頭暈的診斷治療課件45心因性頭暈的診斷治療課件46心因性頭暈的診斷治療課件47心因性頭暈的診斷治療課件48心因性頭暈的診斷治療課件49心因性頭暈的診斷治療課件50心因性頭暈的診斷治療課件51心因性頭暈的診斷治療課件52心因性頭暈的診斷治療課件53心因性頭暈的診斷治療課件5466、節(jié)制使快樂增加并使享受加強(qiáng)?！轮兛死?/p>

67、今天應(yīng)做的事沒有做，明天再早也是耽誤了?！崴固┞妪R

68、決定一個(gè)人的一生，以及整個(gè)命運(yùn)的，只是一瞬之間?！璧?/p>

69、懶人無法享受休息之樂?！伎?/p>

70、浪費(fèi)時(shí)間是一樁大罪過?！R梭66、節(jié)制使快樂增加并使享受加強(qiáng)?！轮兛死?5心因性頭暈的診斷治療心因性頭暈的診斷治療56心因性頭暈的診斷治療DiagnosisandTreatmentofPsychogenicDizziness2019-05-09心因性頭暈的診斷治療57內(nèi)容概要一、頭暈的概念及癥候、心因性頭暈的發(fā)生率三、心因性頭暈的臨床表現(xiàn)四、心因性頭暈的發(fā)病因素五、心因性頭暈的治療六、心因性頭暈的鑒別診斷七、心因性頭暈的表現(xiàn)舉例2020/5/4海軍總醫(yī)院神內(nèi)容概要58、頭暈的概念及癥候Dizziness:ADiagnosticApproachROBERTEPOST,MD,VirtuaFarmilyMedicineResidencyVoorhees,NewJeLORIM.DICKERSON,PharmD,MedicalUniversityofSouthCarolina,Charleston,SouthCarolinaDizzinessaccountsforanestimated5percentofprimarycareclinicvisits.Thepatienthistorycangenerallyclassifdizzinessintooneoffourcategories:vertigoorlightheadedness,Themaincausesofvertigoarebenignparoxysmalpositionalvertigo,Meniease,vestibuletisandlabyrinthitis.Manymedicationscancausepresyncope,andregimensshouldbeassessedinpatientswiththistypeofdizziness,Parkinsondiseaseanddiabeticneuropathyshouldbeconsideredwiththediagnosisofdisequilibrium.Psychiatricdisorders,suchasdepression,anxiety,andhyperventilationsyndrome,cancausevaguelightheadedness.Thedifferentialdiagnosisofdizzinesscanbenarowedwitheasy-to-performphysicalexaminationtests,includingevaluationfornystagmus,theDix-Hallpikemaneuver,andortho-staticbloodpressuretesting.Laboratorytestingandradiographyplaylittleroleindiagnosis.Afinaldiagnosisisnotobtainedinabout0percentofcases.TreatmentofvertigoincludestheEpleymaneu-ver(canalithrepositioning)andvestibularrehabilitationforbenignparoxysmalpositionalvertigo,intratympanicdexamethasoneorgentamicinforMenieredisease,andsteroidsforvestibularneuritis.Orthostatichypotensionthatcausespreynopecanbetreatedwithalphaagonists,mineralocorticoids,orlifestylechanges.Disequilib-riumandlightheadednesscanbealleviatedbytreatingtheunderlyngcause(AmFanPhysician.2010;82(4):361-368.Copyright2010AmericanAcademyofFamilyPhysicians.y、頭暈的概念及癥候59頭暈的概念及癥候“頭暈[dizziness]”的概念分類頭昏[ghtheadedness]:頭沉,大腦不清晰感眩暈[vertigo]:運(yùn)動(dòng)錯(cuò)覺(視覺及主觀感覺旋轉(zhuǎn))暈厥前狀態(tài)[presyncope]:暈,眼前發(fā)黑,心慌失衡[disequilibrium:不穩(wěn)感。一海軍總醫(yī)院神頭暈的概念及癥候60、頭暈的概念及癥候Table1.MainCategoriesofDizzinessPercentagepatiantscategoryDascnDNonwithdizzinessvertIcFalsesenseofmotion45to54possiblyspinningsensatioDIsequilibriumoff-balanceorwobblyupto16PresyncopeFeelIngoflosingconsdoLnessorLightheadednessvaguesymptomsApproxlmatelypossiblyfeelIngdiconnectedwlththeenvIronmentInformationfromreferences4.5.4and8、頭暈的概念及癥候61頭暈/眩暈的概念及癥候Table3.SelectedCausesofDizzinesscategoryMagnesiccenaBenignparoxysmalvertIgoLooseotolithinsemldrauarcanalscausingPosltlvefindIngswithDIx-Haafalsesansaofmotionmaneuver,epodevertiHyperventIlationghtheadednes,Hyperventilationcausingresplratoryalkalosis;SymptomsreproducedwlthvoluntaryunderlyinganxetymayprovokethehyperventillatlonMenieredseasevertigoIncreasedendlymphatkfluidintheInnerearEpisodicvertionwIthhearinglossMigrainousvertigohypothesislsthattrigeminalnucleistimulationcausesnystagmusduringatleasttwoepisodesofvertiOrthostatetopInbloodpressureonposltiondangeSystolicbloodpressuredecreaseof20mmhypotensionusingdecreasedbloodfiowtothebrain,Ho,dlastolicbloodpressuredeceasedverseeffectofmultiplemedicationsof10mmH,orapubeincreaseofiseeTable2)3obeatspermInuteParkinsondeaseisequllbriumDysfunctioningaitcausingimbalancewinaandpossiblePeripheralneuropathyDlsequllbriumDecreasedtactileresponsewhenwalkingDecreasedsenslowerextremities,touchhegroundeadingtombalanceMnformationromeferences4,7,B,and13through20.頭暈/眩暈的概念及癥候62心因性頭暈的發(fā)生率神經(jīng)科頭暈門診200例患者的病因分析NEUROLOGY2019:56436Table2Diagosesin200patientswithandwithoutmigrainepresentingfoaneurologicdumainesclinicDizzinessdiniepatientschmegrouppatientswithmigrainewithoutmigraineia=125)Benignparoxysmalpositionalvertige61(31)21t2540(32DetinitemigrainousvertigO1419Vestibulopathyafunknownorgin心因性頭暈占到20%,其中有偏頭痛史的心因性叫頭暈占6%,無偏頭痛史占14%Vestibularneuritis6{5心因性頭暈的發(fā)生率63、心因性頭暈的發(fā)生率Brandt20195353例神經(jīng)科頭暈門診患者的病因分析TABLE1TheFrequencyofDifferentvertigo/DizzinesSyndromesin5353PatientsSeeninaNeurologicalDizzinessUnitDiagnosisPercentage(%oBenignparoxysmalItionalvertigo99之18.5699Vestibularmigraine55310.3Meniere'sdisease4448.3Vestibularneuritis40teralvestibulopatVestibularparoxysmic173Perilymphfistula0.4Unknownvertigosyndromes214Otherdisorders630l1.8、心因性頭暈的發(fā)生率64回msP加w某m4)80JournalofPsychosomaticResearchELSEVIERShortcommunicationAnxious,introvertedpersonalitytraitsinpatientswithchronicsubjectivedizzinessJeffreyPStaab*,DanielE.RoheScottD.Z.Eggers,NeilTShepards種如山D可知。M《tMNARTICLEINFOABSTRACTwbcschroksDciedizzinessISD)isaneurutkgidisorderadpersistentnot-ermiginaisdainesA中會(huì)d9Mrbe2013ronucdDnetMethdsDatawervabtuctedrwueapwctiwlytromdialrwardaf40patentwladcnaandironsaherthanCSDplusco-exisnnganxeryaespenalitytraitsleafedwattleNEDPeisonirynventary-Revied(NEO-R).andtemperamentsarHATX-adetyseurDSMIwwnthnrexciteerletempetmentsstmglyasdatelwiCsDandmayheaniskadnrluropingsyndronec2013HeverincAllrightsreserved.回msP加w某m4)8065failuretoreturntonormalposturalcontrolafteradaptingtothedemandsofacutevestibularcrises11CSDisnotarareornewconditionitisthesecondmostcommoncauseofdizzinessintertiaryneurotologycentersthattrackit1.Phys-icalsymptomsofCSDaresimilartothose