Title Vrtoglavica kao hitni neurološki simptom Title (english) Vertigo as an urgent neurological symptom Author Robert Gečević Mentor Marina Roje Bedeković (mentor)Committee member Zdravka Poljaković-Skurić (predsjednik povjerenstva)Committee member Mario Habek (član povjerenstva)Committee member Marina Roje Bedeković (član povjerenstva)Granter University of Zagreb Defense date and country 2023-07-13, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Vrtoglavica je subjektivni doživljaj poremećaja orijentacije bolesnika u prostoru, s prisutnom iluzijom kretanja samog bolesnika i/ili prostora koji ga okružuje. Uzroci vrtoglavice dijele se na periferne i centralne. U periferne uzroke vrtoglavice spadaju benigni paroksizmalni pozicijski vertigo, Ménièreova bolest, vestibularni neuritis, labirintitis i drugi. U centralne uzroke vrtoglavice spadaju tranzitorna ishemijska ataka u vertebrobazilarnom slivu, moždani udar u području stražnjeg moždanog krvotoka, multipla skleroza, epilepsija, tumori središnjeg živčanog sustava i drugi. Iako su u bolesnika s vrtoglavicom kao hitnim neurološkim simptomom diferencijalne dijagnoze poput ishemije vertebrobazilarnog sliva i tumora središnjeg živčanog sustava životno ugrožavajuće, najveći broj akutnih vrtoglavica uzrokovan je perifernim poremećajima poput benignog paroksizmalnog pozicijskog vertiga. U dijagnostici bolesnika s akutnom vrtoglavicom u sklopu hitne medicinske službe najvažniji su iscrpan anamnestički pristup i detaljan klinički pregled koji su u najvećem broju slučajeva dovoljni za postavljanje dijagnoze. Točni podaci o trajanju, težini simptoma vrtoglavice, čimbenicima koji su ju izazvali i popratnim simptomima te životnim navikama bolesnika s akutnom vrtoglavicom od izrazite su važnosti. Klinički pregled ima značajnu ulogu u dijagnostici i razlučivanju perifernih od centralnih uzroka. Dix-Hallpike test pokazao se testom visoke osjetljivosti i specifičnosti u dijagnostici bolesnika s BPPV-om, dok je HINTS pregled (Head impulse test, nistagmus, test skew devijacije) također neizostavno sredstvo u razlikovanju perifernih od centralnih uzroka vrtoglavice. Samo manji broj bolesnika s vrtoglavicom u hitnoj službi zahtjeva neuroradiološke metode u dijagnostici. One su korisne ukoliko postoji pravilno postavljena indikacija i ukoliko su rezultati kliničkog pregleda nejasni ili ukazuju na centralne uzroke. Od izrazite je važnosti utvrditi vremenski okvir od nastanka simptoma kako bi se rezultati neuroradioloških pretraga mogli ispravno tumačiti. Liječenje vrtoglavice kao hitnog neurološkog simptoma ovisi o etiologiji bolesti. Periferna etiologija najčešće je benigna, dok centralna često zahtjeva hitno liječenje.
Abstract (english) Vertigo is the subjective experience of the patient's disorientation in space, with the illusion of movement of the patient himself and/or the space that surrounds him. Causes of vertigo are divided into peripheral and central. Peripheral causes of vertigo include benign paroxysmal positional vertigo, Ménière's disease, vestibular neuritis, labyrinthitis and others. Central causes of vertigo include transient ischemic attack in the vertebrobasilar arterial system, ischemic posterior circulation stroke, multiple sclerosis, epilepsy, tumors of the central nervous system, and others. Although in patients with vertigo as an urgent neurological symptom, differential diagnoses such as ischemia of the vertebrobasilar circulation and tumors of the central nervous system could be life-threatening, the majority of acute vertigo is caused by peripheral disorders such as benign paroxysmal positional vertigo. In the diagnosis of patients with acute vertigo as part of the emergency medical service, the most important thing is a comprehensive anamnestic approach and a detailed clinical examination, which in most cases are sufficient to establish a diagnosis. Accurate data on the duration, severity of vertigo symptoms, factors that caused it and accompanying symptoms, but also lifestyle habits of patients with acute vertigo are extremely important. Clinical examination and clinical tests play a significant role in diagnosis and distinguishing peripheral from central causes. The Dix-Hallpike test proved to be a test of high sensitivity and specificity in the diagnosis of patients with BPPV. The HINTS examination (head impulse test, nystagmus, test of skew) is also an indispensable tool in differentiating peripheral from central causes of vertigo. Only a small number of patients with vertigo in the emergency department require neuroradiological methods in diagnosis, mainly if a central cause is suspected or when the clinical status remains elusive. It is extremely important to determine the time frame of the onset of symptoms so that the results of neuroradiological examinations can be interpreted correctly. The treatment of vertigo as an urgent neurological symptom depends on the etiology of the disease. Central etiology often requires urgent treatment.
Keywords
centralna vrtoglavica
hitno stanje
periferna vrtoglavica
Keywords (english)
central vertigo
emergency
peripheral vertigo
Language croatian URN:NBN urn:nbn:hr:105:758201 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2023-10-24 10:10:52
