心因性头晕的诊断治疗课件

心因性头晕的诊断治疗心因性头晕的诊断治疗1心因性头晕的诊断治疗DiagnosisandTreatmentofPsychogenicDizziness2019-05-09心因性头晕的诊断治疗2内容概要一、头晕的概念及症候、心因性头晕的发生率三、心因性头晕的临床表现四、心因性头晕的发病因素五、心因性头晕的治疗六、心因性头晕的鉴别诊断七、心因性头晕的表现举例2020/5/4海军总医院神内容概要3、头晕的概念及症候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、头晕的概念及症候4头晕的概念及症候“头晕[dizziness]”的概念分类头昏[ghtheadedness]:头沉,大脑不清晰感眩晕[vertigo]:运动错觉(视觉及主观感觉旋转)晕厥前状态[presyncope]:晕,眼前发黑,心慌失衡[disequilibrium:不稳感。一海军总医院神头晕的概念及症候5、头晕的概念及症候Table1.MainCategoriesofDizzinessPercentagepatiantscategoryDascnDNonwithdizzinessvertIcFalsesenseofmotion45to54possiblyspinningsensatioDIsequilibriumoff-balanceorwobblyupto16PresyncopeFeelIngoflosingconsdoLnessorLightheadednessvaguesymptomsApproxlmatelypossiblyfeelIngdiconnectedwlththeenvIronmentInformationfromreferences4.5.4and8、头晕的概念及症候6头晕/眩晕的概念及症候Table3.SelectedCausesofDizzinesscategoryMagnesiccenaBenignparoxysmalvertIgoLooseotolithinsemldrauarcanalscausingPosltlvefindIngswithDIx-Haafalsesansaofmotionmaneuver,epodevertiHyperventIlationghtheadednes,Hyperventilationcausingresplratoryalkalosis;SymptomsreproducedwlthvoluntaryunderlyinganxetymayprovokethehyperventillatlonMenieredseasevertigoIncreasedendlymphatkfluidintheInnerearEpisodicvertionwIthhearinglossMigrainousvertigohypothesislsthattrigeminalnucleistimulationcausesnystagmusduringatleasttwoepisodesofvertiOrthostatetopInbloodpressureonposltiondangeSystolicbloodpressuredecreaseof20mmhypotensionusingdecreasedbloodfiowtothebrain,Ho,dlastolicbloodpressuredeceasedverseeffectofmultiplemedicationsof10mmH,orapubeincreaseofiseeTable2)3obeatspermInuteParkinsondeaseisequllbriumDysfunctioningaitcausingimbalancewinaandpossiblePeripheralneuropathyDlsequllbriumDecreasedtactileresponsewhenwalkingDecreasedsenslowerextremities,touchhegroundeadingtombalanceMnformationromeferences4,7,B,and13through20.头晕/眩晕的概念及症候7心因性头晕的发生率神经科头晕门诊200例患者的病因分析NEUROLOGY2019:56436Table2Diagosesin200patientswithandwithoutmigrainepresentingfoaneurologicdumainesclinicDizzinessdiniepatientschmegrouppatientswithmigrainewithoutmigraineia=125)Benignparoxysmalpositionalvertige61(31)21t2540(32DetinitemigrainousvertigO1419Vestibulopathyafunknownorgin心因性头晕占到20%,其中有偏头痛史的心因性叫头晕占6%,无偏头痛史占14%Vestibularneuritis6{5心因性头晕的发生率8、心因性头晕的发生率Brandt20195353例神经科头晕门诊患者的病因分析TABLE1TheFrequencyofDifferentvertigo/DizzinesSyndromesin5353PatientsSeeninaNeurologicalDizzinessUnitDiagnosisPercentage(%oBenignparoxysmalItionalvertigo99之18.5699Vestibularmigraine55310.3Meniere'sdisease4448.3Vestibularneuritis40teralvestibulopatVestibularparoxysmic173Perilymphfistula0.4Unknownvertigosyndromes214Otherdisorders630l1.8、心因性头晕的发生率9回msP加w某m4)80JournalofPsychosomaticResearchELSEVIERShortcommunicationAnxious,introvertedpersonalitytraitsinpatientswithchronicsubjectivedizzinessJeffreyPStaab*,DanielE.RoheScottD.Z.Eggers,NeilTShepards种如山D可知。M《tMNARTICLEINFOABSTRACTwbcschroksDciedizzinessISD)isaneurutkgidisorderadpersistentnot-ermiginaisdainesA中会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海军总医院神经内科failuretoreturntonormalpo11心因性头晕的诊断治疗课件12心因性头晕的诊断治疗课件13心因性头晕的诊断治疗课件14心因性头晕的诊断治疗课件15心因性头晕的诊断治疗课件16心因性头晕的诊断治疗课件17心因性头晕的诊断治疗课件18心因性头晕的诊断治疗课件19心因性头晕的诊断治疗课件20心因性头晕的诊断治疗课件21心因性头晕的诊断治疗课件22心因性头晕的诊断治疗课件23心因性头晕的诊断治疗课件24心因性头晕的诊断治疗课件25心因性头晕的诊断治疗课件26心因性头晕的诊断治疗课件27心因性头晕的诊断治疗课件28心因性头晕的诊断治疗课件29心因性头晕的诊断治疗课件30心因性头晕的诊断治疗课件31心因性头晕的诊断治疗课件32心因性头晕的诊断治疗课件33心因性头晕的诊断治疗课件34心因性头晕的诊断治疗课件35心因性头晕的诊断治疗课件36心因性头晕的诊断治疗课件37心因性头晕的诊断治疗课件38心因性头晕的诊断治疗课件39心因性头晕的诊断治疗课件40心因性头晕的诊断治疗课件41心因性头晕的诊断治疗课件42心因性头晕的诊断治疗课件43心因性头晕的诊断治疗课件44心因性头晕的诊断治疗课件45心因性头晕的诊断治疗课件46心因性头晕的诊断治疗课件47心因性头晕的诊断治疗课件48心因性头晕的诊断治疗课件49心因性头晕的诊断治疗课件50心因性头晕的诊断治疗课件51心因性头晕的诊断治疗课件52心因性头晕的诊断治疗课件53心因性头晕的诊断治疗课件5466、节制使快乐增加并使享受加强。——德谟克利特

67、今天应做的事没有做，明天再早也是耽误了。——裴斯泰洛齐

68、决定一个人的一生，以及整个命运的，只是一瞬之间。——歌德

69、懒人无法享受休息之乐。——拉布克

70、浪费时间是一桩大罪过。——卢梭66、节制使快乐增加并使享受加强。——德谟克利特55心因性头晕的诊断治疗心因性头晕的诊断治疗56心因性头晕的诊断治疗DiagnosisandTreatmentofPsychogenicDizziness2019-05-09心因性头晕的诊断治疗57内容概要一、头晕的概念及症候、心因性头晕的发生率三、心因性头晕的临床表现四、心因性头晕的发病因素五、心因性头晕的治疗六、心因性头晕的鉴别诊断七、心因性头晕的表现举例2020/5/4海军总医院神内容概要58、头晕的概念及症候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、头晕的概念及症候59头晕的概念及症候“头晕[dizziness]”的概念分类头昏[ghtheadedness]:头沉,大脑不清晰感眩晕[vertigo]:运动错觉(视觉及主观感觉旋转)晕厥前状态[presyncope]:晕,眼前发黑,心慌失衡[disequilibrium:不稳感。一海军总医院神头晕的概念及症候60、头晕的概念及症候Table1.MainCategoriesofDizzinessPercentagepatiantscategoryDascnDNonwithdizzinessvertIcFalsesenseofmotion45to54possiblyspinningsensatioDIsequilibriumoff-balanceorwobblyupto16PresyncopeFeelIngoflosingconsdoLnessorLightheadednessvaguesymptomsApproxlmatelypossiblyfeelIngdiconnectedwlththeenvIronmentInformationfromreferences4.5.4and8、头晕的概念及症候61头晕/眩晕的概念及症候Table3.SelectedCausesofDizzinesscategoryMagnesiccenaBenignparoxysmalvertIgoLooseotolithinsemldrauarcanalscausingPosltlvefindIngswithDIx-Haafalsesansaofmotionmaneuver,epodevertiHyperventIlationghtheadednes,Hyperventilationcausingresplratoryalkalosis;SymptomsreproducedwlthvoluntaryunderlyinganxetymayprovokethehyperventillatlonMenieredseasevertigoIncreasedendlymphatkfluidintheInnerearEpisodicvertionwIthhearinglossMigrainousvertigohypothesislsthattrigeminalnucleistimulationcausesnystagmusduringatleasttwoepisodesofvertiOrthostatetopInbloodpressureonposltiondangeSystolicbloodpressuredecreaseof20mmhypotensionusingdecreasedbloodfiowtothebrain,Ho,dlastolicbloodpressuredeceasedverseeffectofmultiplemedicationsof10mmH,orapubeincreaseofiseeTable2)3obeatspermInuteParkinsondeaseisequllbriumDysfunctioningaitcausingimbalancewinaandpossiblePeripheralneuropathyDlsequllbriumDecreasedtactileresponsewhenwalkingDecreasedsenslowerextremities,touchhegroundeadingtombalanceMnformationromeferences4,7,B,and13through20.头晕/眩晕的概念及症候62心因性头晕的发生率神经科头晕门诊200例患者的病因分析NEUROLOGY2019:56436Table2Diagosesin200patientswithandwithoutmigrainepresentingfoaneurologicdumainesclinicDizzinessdiniepatientschmegrouppatientswithmigrainewithoutmigraineia=125)Benignparoxysmalpositionalvertige61(31)21t2540(32DetinitemigrainousvertigO1419Vestibulopathyafunknownorgin心因性头晕占到20%,其中有偏头痛史的心因性叫头晕占6%,无偏头痛史占14%Vestibularneuritis6{5心因性头晕的发生率63、心因性头晕的发生率Brandt20195353例神经科头晕门诊患者的病因分析TABLE1TheFrequencyofDifferentvertigo/DizzinesSyndromesin5353PatientsSeeninaNeurologicalDizzinessUnitDiagnosisPercentage(%oBenignparoxysmalItionalvertigo99之18.5699Vestibularmigraine55310.3Meniere'sdisease4448.3Vestibularneuritis40teralvestibulopatVestibularparoxysmic173Perilymphfistula0.4Unknownvertigosyndromes214Otherdisorders630l1.8、心因性头晕的发生率64回msP加w某m4)80JournalofPsychosomaticResearchELSEVIERShortcommunicationAnxious,introvertedpersonalitytraitsinpatientswithchronicsubjectivedizzinessJeffreyPStaab*,DanielE.RoheScottD.Z.Eggers,NeilTShepards种如山D可知。M《tMNARTICLEINFOABSTRACTwbcschroksDciedizzinessISD)isaneurutkgidisorderadpersistentnot-ermiginaisdainesA中会d9Mrbe2013ronucdDnetMethdsDatawervabtuctedrwueapwctiwlytromdialrwardaf40patentwladcnaandironsaherthanCSDplusco-exisnnganxeryaespenalitytraitsleafedwattleNEDPeisonirynventary-Revied(NEO-R).andtemperamentsarHATX-adetyseurDSMIwwnthnrexciteerletempetmentsstmglyasdatelwiCsDandmayheaniskadnrluropingsyndronec2013HeverincAllrightsreserved.回msP加w某m4)8065failuretoreturntonormalposturalcontrolafteradaptingtothedemandsofacutevestibularcrises11CSDisnotarareornewconditionitisthesecondmostcommoncauseofdizzinessintertiaryneurotologycentersthattrackit1.Phys-icalsymptomsofCSDaresimilartothose