ベッドの中でめまいが酷くなることが特徴． With respect to history, the key observation is that dizziness is triggered by lying down, or on rolling over in bed. Most other conditions that have positional dizziness get worse on standing rather than lying down (e.g. orthostatic hypotension ).
Humphriss RL, Baguley DM, Sparkes V, Peerman SE, Moffat DA. Contraindications to the Dix-Hallpike manoeuvre: a multidisciplinary review.Int J Audiol. 2003 Apr;42(3):166-73. The Dix-Hallpike manoeuvre is widely used in the diagnosis of positional vertigo and is regarded as safe. The manoeuvre involves a degree of neck rotation and extension, and consequently one might expect there to be some patients, particularly those with neck problems in whom the manoeuvre is contraindicated. The term 'neck problem', however, encompasses a whole range of conditions, including soft tissue disorders, cervical spondylosis, prolapsed intervertebral disk, and severe rheumatoid arthritis with cervical instability. These in turn will give rise to a variety of symptoms, which will vary from minimal pain or stiffness to severe pain or complete immobility, and, in some cases, neurological deficit. Clarification is therefore needed to establish the point at which any neck pain or stiffness ceases to be a minor problem and becomes a contraindication to performing the Dix Hallpike manoeuvre. This paper clarifies this issue by discussing the issue of absolute contraindications and proposing a simple functional assessment of neck mobility which can be performed prior to performing the Dix Hallpike manoeuvre. Relative contraindications such as back pathology, vertebrobasilar ischaemia (posterior circulation ischaemic disease), nerve root compression and medical fitness are also discussed.
Physical therapy for benign paroxysmal positional vertigo. Brandt T , Daroff RB . We treated 67 patients with the symptoms of benign paroxysmal positional vertigo (BPPV) by challenging them with the precipitating head positions on a repeated and serial basis. Sixty-six of the patients experienced complete relief of the vertigo within three to 14 days; in two patients, the vertigo recurred but responded to a second course of therapy. The one patient whose condition did not respond was found to have a perilymphatic fistula that mimicked BPPV. The presumed mechanism for this therapy is the loosening and ultimate dispersion of degenerated otolithic particles from the cupula of the posterior semicircular canal.
Amarenco P, Roullet E, Hommel M, Chaine P, Marteau R. Related Articles, Links Infarction in the territory of the medial branch of the posterior inferior cerebellar artery. J Neurol Neurosurg Psychiatry. 1990 Sep;53(9):731-5. Masson C, Sterkers O, Chaigne P, Colombani JM, Masson M. Related Articles, Links [Isolated vertigo disclosing infarction in the area of the posterior and inferior cerebellar arteries] Ann Otolaryngol Chir Cervicofac. 1992;109(2):80-6. Review. French. こういうケースはどんな専門医でも困る．何か特定の検査で異常が出るわけではない．逆に言えば，専門医の知識や技術が何の役も立たないのだから，こういうケースこそプライマリ・ケア医の出番であって，患者さんの年齢，既往歴といった基本情報から，脳血管障害のリスクファクターを割り出す，地道な作業はもちろんのこと，患者さんや家族の希望をよく聞き，不安感を推し量り仕事の予定，忙しさといった社会的な要素も勘案し，専門医への紹介のタイミングや検査予定を組むのがプライマリ・ケア医の持ち味である． ポイントは，基本．好発年齢や，脳血管障害のリスクファクターを考える
