めまいの診断手順 ; 問診による初期区分と急性めまいにおける脳卒中鑑別の Strategy

抄録

　We have reviewed previously reported procedures for diagnosing vertigo, dizziness and imbalance. Most experts recommend first distinguishing between pre-syncope and other symptoms. The symptoms are then classified into 4 or 5 categories according to the clinical history (acute or chronic, triggered or spontaneous, continuous or episodic). Further differential diagnosis is then needed in each category. A recent trend in the classification is not to focus on rotational vertigo or non-rotational dizziness as a symptom.

　The most important consideration in diagnosing the cause of acute vertigo is stroke detection, which is often difficult to distinguish from peripheral vestibular disorders. There are three possible strategies: (1) use of an algorithm, such as a flowchart, (2) defining symptoms/findings suggestive of a stroke, and (3) scoring and evaluation of the symptoms/findings. The sensitivity and specificity are increased by defining multiple symptoms and findings suggestive of stroke. However, if many specialized findings are required, it lacks versatility as a diagnostic procedure. The optimal strategy differs depending on the situation, the target patient, and the doctor. The strategies are expected to continue to be evaluated and improved.