Сосудистое головокружение

Головокружение является распространенным симптомом, который может быть вызван различными патофизиологическими механизмами и встречается при многих заболеваниях. Как правило, головокружение обусловлено доброкачественными причинами, но в некоторых случаях оно может указывать на наличие жизнеугрожающих заболеваний. В зависимости от течения выделяют острый, эпизодический и хронический вестибулярные синдромы. Цереброваскулярная патология может быть одной из причин вестибулярного головокружения. При этом преходящее изолированное головокружение является одним из наиболее распространенных предвестников транзиторной ишемической атаки в вертебробазилярном бассейне. Ишемический инсульт рассматривается как наиболее частая причина центрального острого вестибулярного синдрома. Инсульты, проявляющиеся вестибулярными симптомами, в большинстве случаев возникают при поражении ствола головного мозга или мозжечка, но могут наблюдаться и при поражении полушарий головного мозга. Церебральная болезнь мелких сосудов играет центральную роль в возникновении головокружения у пожилых людей. Выявление сосудистой причины у пациента с острым головокружением является сложной задачей, особенно при отсутствии сопутствующих неврологических симптомов. В последние годы было разработано несколько методов прикроватной диагностики, которые позволяют эффективно дифференцировать периферическое и центральное головокружение. Международное общество Барани разработало и опубликовало диагностические критерии сосудистого головокружения, согласно которым выделяют несколько типов сосудистого головокружения: достоверное острое продолжительное, вероятное острое продолжительное, транзиторное и острое головокружение в развитии, а также вероятное острое головокружение в развитии и вероятное транзиторное головокружение. Лечение головокружения включает фармакологические, физиотерапевтические, психотерапевтические/поведенческие и, реже, хирургические подходы. Часто применяют комбинацию различных методов. Выбор терапии определяется патофизиологией и этиологией головокружения.

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