Common diseaseとしてのめまい—危険度で考える

Vertigo/Dizziness as a Common Disease: Thinking in Terms of Risk

めまいは脳神経内科や救急外来でコモンな主訴の1つであるが，自己限定的で良性の病態が多い。しかし，重大で危険な原因がまだまだ見逃されている。本論では，末梢から中枢までの前庭系の解剖学とめまいの内容分析（回転性か浮動性か）よりも誘発因子と時間経過に重きを置いた分類を提示する。そのうえで，原因を危険性の高いもの，要注意のものそして自己限定的なものに分けて，単独めまいや単独前庭性症候群を中心に，解説する。

Abstract

Vertigo and dizziness are among the most common chief complaints in the neurology and emergency departments. Benign, self-limiting peripheral causes such as benign positional paroxysmal vertigo or vestibular neuropathy, Ménière's disease are the majority, but dangerous underlying conditions such as cerebrovascular or cardiovascular diseases are still overlooked. In this paper, the anatomy of the vestibular network from peripheral to central and the classification based on “triggers and timing” rather than the analysis of patient's word (rotational versus dizzy) are presented. Based on these, I classify various causes of vertigo and dizziness into three groups, i.e. highly dangerous, less dangerous but cautionary, and benign self-limiting ones, and explain them focusing on isolated vertigo or isolated vestibular syndrome.