| Abstract | Vrtoglavice predstavljaju značajan javnozdravstveni problem i njihova učestalost je velika. Zajedno s glavoboljom, umorom, bolovima u leđima i ostalim poremećajima ravnoteže pripadaju najčešćim simptomima ambulantnih bolesnika. U kliničkoj praksi približno 40% bolesnika ima vrtoglavicu uzrokovanu perifernim vestibularnim poremećajem, 10% bolesnika ima oštećenje središnjih vestibularnih struktura, 15% ima psihijatrijske poremećaje, a 25% ima vrtoglavicu uzrokovanu drugim poremećajima poput presinkope ili poremećaja ravnoteže. U približno 10% bolesnika točan uzrok nastanka vrtoglavice ostaje neutvrđen.
Vertigo je tip vrtoglavice koji se manifestira snažnom iluzijom kretanja bolesnika ili njegove okoline u prostoru. Vodeći je simptom središnjeg vestibularnog poremećaja. Središnji vestibularni poremećaj uzrokovan je bolešću ili poremećajem središnjeg vestibularnog sustava na razini moždanog debla, malog mozga ili moždane kore. Središnji vertigo može biti dio kliničke slike nasljednih, zaraznih, neoplastičkih, metaboličkih, toksičkih, vaskularnih, traumatskih i autoimunih bolesti. Najčešće se javlja u sklopu cerebrovaskularnih bolesti vertebrobazilarnog sliva, tumora središnjeg živčanog sustava, multiple skleroze, epilepsije i migrene.
Cilj osnovnog pristupa bolesniku s vertigom je razlučiti je li riječ o perifernom ili središnjem vestibularnom poremećaju te postoje li smetnje koje upućuju na hitno neurološko stanje. Anamneza i klinički pregled temelj su dijagnosticiranja zajedno s neuroradiološkim metodama. Magnetska rezonanca je dijagnostička metoda prvoga izbora u slučaju sumnje na središnji vertigo.
Većinu vestibularnih poremećaja, koji dovode do vertiga, moguće je uspješno liječiti. Iako zbog pogrešnog dijagnosticiranja, često ostaju nedovoljno ili neprikladno liječeni što dovodi do kronifikacije simptoma, produljenih izostanaka s radnog mjesta te izvođenja dodatnih, nepotrebnih i skupih dijagnostičkih pretraga. |
| Abstract (english) | Dizziness represents a major public health problem which, together with headache, fatigue, back pain, and other balance disorders, belongs to a group of most frequent symptoms in primary health care patients. In clinical practice about 40% of patients suffer from vertigo that is caused by a peripheral vestibular disorder, 10% have damaged central vestibular structures, 15% have some sort of psychiatric disorder, in 25% vertigo is caused by some other disorder like presyncope or balance disorders. In 10% of patients, the cause cannot be determined.
Vertigo is a type of headache that manifests by the strong illusion of patient’s moving or moving surrounding, and it is the main symptom of central vestibular dysfunction. Central vestibular dysfunction is caused by an illness or a disorder of the central vestibular system in the brainstem, cerebellum, or cerebral cortex. Central vertigo can be caused by hereditary, contagious, neoplastic, metabolic, toxic, vascular, traumatic, and autoimmune diseases. It is most commonly present in cerebrovascular diseases, vertebrobasilar basin, and tumor of the central nervous system, multiple sclerosis, epilepsy, and migraines.
The main principle of treating vertigo lies in detecting whether it is caused by the peripheral or central vestibular disorder and if the interferences refer to emergency neurological state. Anamnesis and clinical examination are the base of diagnostics together with neuroradiological methods. Magnetic resonance is the first choice for a diagnostic method in suspicion of central vertigo.
Most of the vestibular disorders that lead to dizziness can be successfully treated. But even though that is the case, because of misdiagnosing, they remain insufficiently or inappropriately treated which leads to symptom chronification, longer absence from work, and expensive and unnecessary diagnostic procedures. |
