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Современные подходы к диагностике и лечению головокружения
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Kryukov A.I., Kunelskaya N.L., Guseva A.L. Modern approaches to diagnosis and treatment of dizziness. Handbook for Practitioners Doctors. 2018; 6: 75–81.
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Ключевые слова: головокружение, вестибулопатия, вестибулярный синдром.
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The article deals with differential diagnostic algorithm for examining a patient with dizziness. The peripheral and central nervous system diseases causing dizziness are discussed. It also presents diagnostic methods and the main directions of dizziness treatment and prevention.
Key words: dizziness, vestibulopathy, vestibular syndrome.
2. Kroenke K, Jackson JL. Outcome in general medical patients presenting with common symptoms: a prospective study with a 2-week and a 3-month follow-up. Fam Pract 1998; 15 (5): 398Y403. DOI: 10.1093/fampra/15.5.398
3. Hoffman RM, Einstadter D, Kroenke K. Evaluating dizziness. Am J Med 1999; 107 (5): 468–78.
4. Newman-Toker DE, Cannon LM, Stofferahn ME et al. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc 2007; 82 (11): 1329–40.
5. Kerber KA, Newman-Toker DE. Misdiagnosing dizzy patients. Common pitfalls in clinical practice. Neurol Clin 2015; 33 (3): 565–75.
6. Newman-Toker DE, Edlow JA. TiTrATE. A novel, evidence-based approach to diagnosing acute dizziness and vertigo. Neurol Clin 2015; 33 (3): 577–99.
7. Von Brevern M, Radtke A, Lezius F et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007; 78: 710–5.
8. Bhattacharyya N, Gubbels SP, Schwartz SR et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary. Otolaryngol Head Neck Surg 2017; 156 (3): 403–16. DOI: 10.1177/0194599816689660
9. Dix MR, Hallpike CS. The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med 1952; 45: 341–54.
10. Colledge NR, Barr-Hamilton RM, Lewis SJ et al. Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ 1996; 313 (7060): 788–92.
11. Shoair OA, Nyandege AN, Slattum PW. Medication-related dizziness in the older adult. Otolaryngol Clin North Am 2011; 44 (2): 455–71.
12. Lopez-Escamez JA, Carey J, Chung WH et al; Classification Committee of the Barany Society; Japan Society for Equilibrium Research; European Academy of Otology and Neurotology (EAONO); Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS); Korean Balance Society. Diagnostic criteria for Menière's disease. J Vestib Res 2015; 25 (1): 1–7. DOI: 10.3233/VES-150549
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14. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33 (9): 629–808. https://doi.org/10.1177/0333102413485658
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18. Dieterich M, Staab JP, Brandt T. Functional (psychogenic) dizziness. Handb Clin Neurol 2016; 139: 447–68. DOI: 10.1016/B978-0-12-801772-2.00037-0
19. Parell GJ, Becker GD. Conservative management of inner ear barotrauma resulting from scuba diving. Otolaryngol Head Neck Surg 1985; 93: 393.
20. Ishman SL, Friedland DR. Temporal bone fractures: traditional classification and clinical relevance. Laryngoscope 2004; 114: 1734.
21. Maarsingh OR, Dros J, Schellevis FG et al. Causes of persistent dizziness in elderly patients in primary care. Ann Fam Med 2010; 8 (3): 196–205.
22. Tinetti ME, Williams CS, Gill TM. Dizziness among older adults: a possible geriatric syndrome. Ann Intern Med 2000; 132 (5): 337–44.
23. Muncie HL, Sirmans SM, James E. Dizziness: Approach to Evaluation and Management. Am Fam Physician 2017; 95 (3): 154–62.
24. Кунельская Н.Л., Гусева А.Л., Байбакова Е.В. и др. Головокружение в пожилом возрасте: особенности течения и возможности реабилитации. Consilium Medicum. 2017; 19 (2.1): 94–7. / Kunelskaia N.L., Guseva A.L., Baibakova E.V. et al. Vertigo in the elderly age: the features of the course and the possibility of rehabilitation. Consilium Medicum. 2017; 19 (2.1): 94–7. [in Russian]
25. Newman-Toker DE, Hsieh YH, Camargo CAJr et al. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc 2008; 83 (7): 765–5.
26. Wood KA, Drew BJ, Scheinman MM. Frequency of disabling symptoms in supraventricular tachycardia. Am J Cardiol 1997; 79 (2): 145–9.
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28. Kattah JC, Talkad AV, Wang DZ et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40 (11): 3504–10. DOI: 10.1161/STROKEAHA.109.551234
29. Гусев Е.И., Мартынов М.Ю., Камчатнов П.Р. и др. Церебральный инсульт. Consilium Medicum. 2014; 16 (12): 13–7. / Gusev E.I., Martynov M.Iu., Kamchatnov P.R. i dr. Tserebral'nyi insul't. Consilium Medicum. 2014; 16 (12): 13–7. [in Russian]
30. Батышева Т.Т., Костенко Е.В., Ганжула П.А. и др. Комплексная программа вторичной профилактики инсульта: место препарата Вазобрал. Consilium Medicum. 2007; 9 (2): 79–82. / Batysheva T.T., Kostenko E.V., Ganzhula P.A. i dr. Kompleksnaia programma vtorichnoi profilaktiki insul'ta: mesto preparata Vazobral. Consilium Medicum. 2007; 9 (2): 79–82. [in Russian]
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1. Post RE, Dickerson LM. Dizziness: a diagnostic approach. Am Fam Physician. 2010; 82 (4): 361–8, 369.
2. Kroenke K, Jackson JL. Outcome in general medical patients presenting with common symptoms: a prospective study with a 2-week and a 3-month follow-up. Fam Pract 1998; 15 (5): 398Y403. DOI: 10.1093/fampra/15.5.398
3. Hoffman RM, Einstadter D, Kroenke K. Evaluating dizziness. Am J Med 1999; 107 (5): 468–78.
4. Newman-Toker DE, Cannon LM, Stofferahn ME et al. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc 2007; 82 (11): 1329–40.
5. Kerber KA, Newman-Toker DE. Misdiagnosing dizzy patients. Common pitfalls in clinical practice. Neurol Clin 2015; 33 (3): 565–75.
6. Newman-Toker DE, Edlow JA. TiTrATE. A novel, evidence-based approach to diagnosing acute dizziness and vertigo. Neurol Clin 2015; 33 (3): 577–99.
7. Von Brevern M, Radtke A, Lezius F et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007; 78: 710–5.
8. Bhattacharyya N, Gubbels SP, Schwartz SR et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary. Otolaryngol Head Neck Surg 2017; 156 (3): 403–16. DOI: 10.1177/0194599816689660
9. Dix MR, Hallpike CS. The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med 1952; 45: 341–54.
10. Colledge NR, Barr-Hamilton RM, Lewis SJ et al. Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ 1996; 313 (7060): 788–92.
11. Shoair OA, Nyandege AN, Slattum PW. Medication-related dizziness in the older adult. Otolaryngol Clin North Am 2011; 44 (2): 455–71.
12. Lopez-Escamez JA, Carey J, Chung WH et al; Classification Committee of the Barany Society; Japan Society for Equilibrium Research; European Academy of Otology and Neurotology (EAONO); Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS); Korean Balance Society. Diagnostic criteria for Menière's disease. J Vestib Res 2015; 25 (1): 1–7. DOI: 10.3233/VES-150549
13. Palchun V.T., Guseva A.L., Levina Y.V. Ménière's disease: epidemiology, etiology, diagnostics, management. Consilium Medicum. 2016; 18 (3): 107–16. [in Russian]
14. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33 (9): 629–808. https://doi.org/10.1177/0333102413485658
15. Osipova V.V., Filatova E.G., Artemenko A.R. i dr. Diagnostika i lechenie migreni: rekomendatsii rossiiskikh ekspertov. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. Spetsvyp. 2017; 117 (1): 28–42. DOI: 10.17116/jnevro20171171228-42 [in Russian]
16. Diukova G.M., Zamergrad M.V., Golubev V.L. i dr. Funktsional'noe (psikhogennoe) golovokruzhenie. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. 2017; 117 (6): 91–8. DOI: 10.17116/jnevro20171176191-98 [in Russian]
17. Filatova E.G. Diagnostika i lechenie psikhogennogo golovokruzheniia. Lechashchii vrach. 2009; 5: 9–11. [in Russian]
18. Dieterich M, Staab JP, Brandt T. Functional (psychogenic) dizziness. Handb Clin Neurol 2016; 139: 447–68. DOI: 10.1016/B978-0-12-801772-2.00037-0
19. Parell GJ, Becker GD. Conservative management of inner ear barotrauma resulting from scuba diving. Otolaryngol Head Neck Surg 1985; 93: 393.
20. Ishman SL, Friedland DR. Temporal bone fractures: traditional classification and clinical relevance. Laryngoscope 2004; 114: 1734.
21. Maarsingh OR, Dros J, Schellevis FG et al. Causes of persistent dizziness in elderly patients in primary care. Ann Fam Med 2010; 8 (3): 196–205.
22. Tinetti ME, Williams CS, Gill TM. Dizziness among older adults: a possible geriatric syndrome. Ann Intern Med 2000; 132 (5): 337–44.
23. Muncie HL, Sirmans SM, James E. Dizziness: Approach to Evaluation and Management. Am Fam Physician 2017; 95 (3): 154–62.
24. Kunelskaia N.L., Guseva A.L., Baibakova E.V. et al. Vertigo in the elderly age: the features of the course and the possibility of rehabilitation. Consilium Medicum. 2017; 19 (2.1): 94–7. [in Russian]
25. Newman-Toker DE, Hsieh YH, Camargo CAJr et al. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc 2008; 83 (7): 765–5.
26. Wood KA, Drew BJ, Scheinman MM. Frequency of disabling symptoms in supraventricular tachycardia. Am J Cardiol 1997; 79 (2): 145–9.
27. Suvorov A.Iu., Samsygina O.M., Ivanova G.E., Efremova N.M. Organizatsionnye aspekty provedeniia reabilitatsionnykh meropriiatii v ostreishii period tserebral'nogo insul'ta. Lechebnaia fizkul'tura i sportivnaia meditsina. 2009; 8: 45–9. [in Russian]
28. Kattah JC, Talkad AV, Wang DZ et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40 (11): 3504–10. DOI: 10.1161/STROKEAHA.109.551234
29. Gusev E.I., Martynov M.Iu., Kamchatnov P.R. i dr. Tserebral'nyi insul't. Consilium Medicum. 2014; 16 (12): 13–7. [in Russian]
30. Batysheva T.T., Kostenko E.V., Ganzhula P.A. i dr. Kompleksnaia programma vtorichnoi profilaktiki insul'ta: mesto preparata Vazobral. Consilium Medicum. 2007; 9 (2): 79–82. [in Russian]
1 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1;
2 ГБУЗ «Научно-исследовательский клинический институт оториноларингологии им. Л.И.Свержевского» Департамента здравоохранения г. Москвы. 117152, Россия, Москва, Загородное ш., д. 18А, стр. 2
*alexandra.guseva@gmail.com
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A.I.Kryukov1,2, N.L.Kunelskaya1,2, A.L.Guseva*1
1 N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1;
2 L.I.Sverzhevsky Research Clinical Institute of Otorhinolaryngology of the Department of Health of Moscow. 117152, Russian Federation, Moscow, Zagorodnoe sh., d. 18A, str. 2
*alexandra.guseva@gmail.com