頭部外傷後眩暈

Vertigo Following Head Injury

趙庭寬(Ting-Kuang Chao) ； 楊怡和(Yi-Ho Young)

《中華民國耳鼻喉科醫學雜誌》 34卷5期 (1999/09) Pp. 385-388

https://doi.org/10.6286/1999.34.5.385

摘要

背景：頭部外傷後的眩暈其病因及病程變異頗大，其中不乏致命的顱內出血，故鑑別診斷至為重要。
方法：自1991年12月至1997年8月，計42例頭部外傷後之眩暈病患，前來求診。年齡分佈在11至70歲之間，平均為43歲，男女比例相當。所有病人均接受詳細的病史詢問、理學檢查、神經學檢查、放射線檢查、血液生化檢查、聽力檢查、及眼振電圖檢查。
結果：顳骨骨折佔12%，良性陣發性位置性眩暈佔40%，顱內出血及震盪後症候群則各佔24%。後二者的眩暈皆在外傷後1週之內發生，其中，顱內出血之眩暈患者70%有聽力異常，40%視覺抑制測驗異常，40%具異常眼球運動；至於震盪後症候群，則聽力檢查正常。
結論：頭部外傷後的眩暈，可藉由臨床表徵、聽力檢查、及眼振電圖檢查來鑑別診斷顱內出血之有無，進而輔以影像學檢查以佐證之。

關鍵字

頭部外傷 ； 眩暈 ； 顱內出血 ； 震盪後症候群

並列摘要

Background: Differentiating intracranial hemorrhage (ICH) from post-trau-matic vertigo is important, since the former can be life-threatening. How to detect ICH becomes a good task, we therefore carried out this study.
Methods: From December 1991 through August 1998, 42 consecutive patients with post-traumatic vertigo were enrolled in this study. All patients received a batter of audiovestibular examinations, including audiometry, blood examinations, plain X-films, and electronystagmography. Magnetic resonance imaging is also performed if central lesion is suspected.
Results: The diagnoses included: 1) intracranial hemorrhage (ICH): 10 cases (24%), 2) postconcussion syndrome (PCS): 10 cases (24%), 3) temporal bone fracture: 5 cases (12%), and 4) benign paroxysmal positional vertigo: 17 cases (40%). The intervals between head injury and vertigo onset aver-aged within 1 week, within 1 week, 1 month, and 6 years respectively. Loss of visual suppression, hearing impairment, and abnormal eye move-ment were significantly higher in the ICH group than the PCS group.
Conclusions: We suggest that detecting the presence of hearing impair-ment, loss of visual suppression, and abnormal eye movement may help in the differential diagnosis between ICH and PCS.

並列關鍵字

head injury ； vertigo ； intracranial hemorrhage ； post-concussion syndrome