高齢者のめまい

― 一次医療機関における MRI を必要とする症例のスクリーニング―

抄録

　　In the aging society, we often encounter elderly patients presenting with vertigo; however, it is not easy to determine which patients might require MRI. Therefore, we tried to screen for patients who might require to undergo MRI at a primary medical facility.

　　We retrospectively examined the records of patients who had developed the symptom of vertigo during the previous one year, who were older than 60 years of age, and in whom a clinical diagnosis had been made. Ten patients who showed acute/old infarcts or arterial stenosis/obstruction on brain MRI, or showed symptoms of TIA (transient ischemic attack), were diagnosed as having vertigo of central origin and were classified into the central group. Forty-six patients were diagnosed as having vertigo of peripheral origin and were classified into the peripheral group.

　　Comparison of the eye movements in these 2 groups revealed direction-fixed horizontal nystagmus and geotropic positional nystagmus only in the peripheral group, whereas, downbeat nystagmus was observed more frequently in the central group. In regard to the subjective description of vertigo, the central group mainly complained of vertigo without a rotating sensation, while the peripheral group mainly complained of vertigo with a rotating sensation.

　　In conclusion, MRI at a primary medical facility may be considered in patients complaining of vertigo without a rotating sensation and those showing downbeat nystagmus.