어지럼증의 신경과적 진찰 (Bedside Neurologic Examination of Dizzy Patients)

서지정보

· 발행기관 : 대한평형의학회
· 수록지 정보 : Research in Vestibular Science / 8권 / 2호 / 18 ~ 21페이지
· 저자명 : 김지수

초록

Differentiating peripheral from central pathology is most important in clinical
practice of dizziness. The bedside examination for dizziness should include a
systematic study of spontaneous and evoked nystagmus, head impulse test,
evaluation of the ocular motilities including saccades, smooth pursuit, and optokinetic
nystagmus. Examination of the balance and coordination function may
disclose dysfunction of the cerebellar system. In contrast to the nystagmus of
peripheral origin, the central nystagmus may show various patterns. Usually
pure vertical and torsional nystagmus, direction-changing nystagmus, and nystagmus
not suppressed by fixation indicates a central pathology. In case of positioning/
positional nystagmus which does not follow the characteristic patterns
of benign paroxysmal positional vertigo and does not respond to repeated canalith
repositioning maneuvers, a possibility of central positional vertigo should
be considered. The patterns of head-shaking nystagmus (HSN) from central lesions
include an unusually strong HSN elicited by weak head-shaking, initially
ipsilesional HSN, strongly biphasic HSN, strong HSN in patients without caloric
paresis, HSN in the opposite direction of spontaneous nystagmus and perverted
HSN (e.g. downbeat nystagmus after horizontal head-shaking). Head impulse
test is mostly negative in the central vestibulopathies, even in the presence
of vertigo and spontaneous nystagmus. Disorders of ocular motility and
coordination, and severe imbalance also suggest central lesions. Careful bedside
evaluation provides valuable information on the underlying pathology of
dizziness.

영어초록

Differentiating peripheral from central pathology is most important in clinical
practice of dizziness. The bedside examination for dizziness should include a
systematic study of spontaneous and evoked nystagmus, head impulse test,
evaluation of the ocular motilities including saccades, smooth pursuit, and optokinetic
nystagmus. Examination of the balance and coordination function may
disclose dysfunction of the cerebellar system. In contrast to the nystagmus of
peripheral origin, the central nystagmus may show various patterns. Usually
pure vertical and torsional nystagmus, direction-changing nystagmus, and nystagmus
not suppressed by fixation indicates a central pathology. In case of positioning/
positional nystagmus which does not follow the characteristic patterns
of benign paroxysmal positional vertigo and does not respond to repeated canalith
repositioning maneuvers, a possibility of central positional vertigo should
be considered. The patterns of head-shaking nystagmus (HSN) from central lesions
include an unusually strong HSN elicited by weak head-shaking, initially
ipsilesional HSN, strongly biphasic HSN, strong HSN in patients without caloric
paresis, HSN in the opposite direction of spontaneous nystagmus and perverted
HSN (e.g. downbeat nystagmus after horizontal head-shaking). Head impulse
test is mostly negative in the central vestibulopathies, even in the presence
of vertigo and spontaneous nystagmus. Disorders of ocular motility and
coordination, and severe imbalance also suggest central lesions. Careful bedside
evaluation provides valuable information on the underlying pathology of
dizziness.

참고자료

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