4. 頸性めまい

抄録

　Cervical vertigo is known as vertigo due to a neck problem. However cervical vertigo remains controversial because there are neither reliable tests nor recognized signs. Supporters of cervical vertigo insist that it is the most common vertigo syndrome. Additionally, some studies demonstrated that stimuli applied to the neck induced nystagmus and dizziness. To date, pathophysiologically four different hypothetical mechanisms have been attributed to cervical vertigo: (1) sympathetic dysfunction; (2) proprioceptive dysfunction; (3) rotational vertebral artery compression (Bow hunter's syndrome); and (4) overlap with migraine associated vertigo. However there are no established tests to diagnose cervical vertigo and diagnosis mostly depends on the patient's past history or subjective complaint such as neck pain. Therefore vestibular or other neurological diseases must be excluded first. Treatment should be specified according to the cause of cervical vertigo. For sympathetic dysfunction due to cervical spondylosis, decompression therapy such as cervical disc decompression might be effective. Physical therapy is reported to be useful for proprioceptive cervical vertigo. In the case of cervical vertigo due to vertebral artery compression, conservative management, decompression surgery and endovascular therapy are major treatment methods. In the future, cervical vertigo is expected to increase due to the expansion of the use of electronic devices such as smartphones. Appropriate clinical examinations and diagnostic criteria should be established urgently.