脳血管障害でみられるめまい 病態生理および画像診断を中心に

Abstract

Vertigo is a subtype of dizziness, which can result from lesions in diverse locations such as the inner ear, neck paravertebral stretch receptors, visual and vestibular interaction centers in the brainstem and cerebellum, and in the integrative balance center of the thalamus or cortex. This study focused on vertigo due to various cerebrovascular diseases secondary to vertebrobasilar system diseases including extracranial causes as well as intracranial etiologies. The most common cerebrovascular disorder to cause vertigo, oscillating vision and impulsion was vertebrobasilar insufficiency secondary to atherosclerosis of the subclavian, vertebral and basilar arteries. However, it is not always clear which structures exhibit ischemia. When vertigo is associated with other symptoms of the brainstem, we can assume that vertigo is caused by ischemia in the exact site of the brainstem. Therefore, meticulous clinical neurological examinations are mandatory including bedside neuro-otological examinations before obtaining neuroimaging studies are performed. Knowledge of the mechanisms that underlie vestibular disorders is essential to correctly diagnose and effectively treat patients with vertigo secondary to cerbrovascular diseases.