末梢性めまい

抄録

Patients who experience a severe attack of dizziness and/or vertigo (D/V) at home often use information from the Government Public Relations Online to decide whether to call an ambulance or not. Therefore, we often see patients with D/V in the emergency room. Between April 17, 2022, and May 24, 2024, 39 patients visited the emergency department of our hospital complaining of D/V and were admitted to our center. Among them, 7 patients were examined by the author first, and all had abnormal neuro-otological findings such as nystagmus. Of the remaining 32 patients, 13 had neurological abnormalities at the time of examination by the author, but the medical records of 7 of these patients stated that there were no neurological abnormalities at the time of their first visit. Of the remaining 19 of the 32 patients, the medical records of 5 patients at the time of their first visit stated that they had abnormal nystagmus. From the above, when the author first examined the patients, neurological abnormalities were found in all cases, but when someone other than the author first examined the patients, 66% (21/32) of the cases were judged as having no neurological abnormalities.

The nystagmus observed in D/V attacks caused by peripheral vestibular diseases such as Meniere’s disease, vestibular neuritis, and sudden hearing loss accompanied by vertigo becomes progressively weaker over a few hours. Also, the direction of the nystagmus may be reversed in cases of Meniere’s disease. Observing the weakening or reversal in the direction of nystagmus is important for diagnosing peripheral D/V diseases.

If benign paroxysmal positional vertigo (BPPV) fatigue can be demonstrated, central vertigo can be excluded. In order to diagnose BPPV in cases where nystagmus is not observed due to BPPV fatigue, it is necessary to observe positional nystagmus using a maneuver to restore the positional nystagmus from BPPV fatigue.