原著 :, retrospective MRI 緒 言 方 法 retrospective,. input dizziness, imbalance
16 人 100 90 80 70 60 50 40 30 20 10 0 図 1 0 10 20 30 40 50 60 70 80 90 MRI MRI MRI mm MRI MRI retrospective 代 人 200 180 160 140 120 100 80 60 40 20 0 0 10 20 30 40 50 60 70 80 90 代 図 2 結 1. めまいの原因疾患, 2. 頚性めまいの症状と画像所見 果
17 MRI. mm. mm. mm MRI MRI 3. 頚性めまいの誘因 A B スポーツ その他 A デスクワーク その他 B デスクワーク TV ゲーム 流れ作業 親の介護 介護職 図 3 A 図 3 B その他 大工仕事 C 草取り庭仕事農作業 デスクワーク 側臥位でのテレビ視聴 図 3 C
18 その他 デスクワーク その他 デスクワーク A 育児 TV ゲームスマートフォンの長時間操作 親の介護介護職 B 育児孫の世話流れ作業 図 4 A 図 4 B その他趣味針仕事 編み物側臥位での TV 視聴 C 草取り庭仕事農作業 図 4 C C PC A B TV A C B C A B A B 4. 頚性めまいの薬物治療
19 人 A 60 50 40 30 20 10 0 夏秋冬春 図 5 A 人 B 160 140 120 100 80 60 40 20 0 夏秋冬春 図 5 B NSAIDs 5. 頚性めまいの予後. MRI
20 MRI MRI 図 7 MRI. T T 図 6 MRI. T T 図 8 MRI. T T
21 図 9 MRI. T T MRI 考 察 1. 良性発作性頭位めまいとの鑑別の重要性 Benign paroxysmal positioning vertigo BPPV BPPV BPPV, BPPV. BPPV 2. 頚性めまいに対する認知度 Barre cervical arthritis Barre-Lieou Ryan Cope spondylosis cervical vertigo,
22 cervicogenic dizziness vertigo, imbalance,,, MRI MRI 3. 頚椎 頚髄疾患からめまいを生じる機序 Barre-Lieou, Powers MRA 4. 脊柱管狭窄症と頚性めまい mm 5. 頚性めまいの治療と予後,,
23 結論 謝辞 著者の COI 開示 文献 Equilibrium Res. 4 Barnsley L, Lord S, Bogduk N. Whiplash injury. Pain 1994 ; 58 : 283 307. Barre JA. Surun syndrome symphathique cervical posterieure et sa cause frequente : I arthrite cervicale. Rev Neurol. 1926 ; 45 : 1246 1248. Cope S, Ryan GMS. Cervical and otolith vertigo. J Laryngol Otol. 1959 ; 73 : 113 120. Ryan GMS, Cope S. Cervical vertigo. Lancet 1955 ; 2 : 1355 1358. Brandt T, Bronstein AM. Cervical vertigo. J Neurol Neurosurg Psychiatry 2001 ; 71 : 8 12. Brown JJ. Cervical contributions to balance. cervical vertigo. In: Berthoz A, Vidal PP, Graf W, editors. The Head Neck Sensory Motor System. Oxford University Press 1992 ; 644 647. Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction. Eur Spine J. 1998 ; 7 : 55 58. Karlberg M, Magnusson M, Malmstrom EM, et al. Postural and symptomatic improvement after physiotherapy in patients with dizziness of suspected cervical origin. Arch Phys Med Rehabil. 1996 ; 77 : 874 882. Norre ME. Cervical vertigo. Diagnostic and semiological problem with special emphasis upon cervical nystagmus. Acta Otorhinolaryngol Belg. 1987 ; 41 : 436 452. Scherer H. Neck-induced vertigo. Arch Otorhinolaryngol 1985 ; 2 : 107 124. Powers SM Jr. Intermittent vertebral artery compression: a new syndrome. Surgery 1961 ; 49 : 257 264. Syndrome sympathique cervicale posterieur- Barre-Lieou Furman JM, Whitney SL. Central causes of dizziness. Phys Ther. 2000 ; 80 : 179 187.
24 Importance of Cervicogenic Dizziness Sho TAKAHASHI To determine the exact cause of dizziness and/or vertigo, 1000 outpatients were retrospectively studied. The most common diagnosis in all of the analyzed cases was cervicogenic dizziness (89%). Among these cases, 600 (67%) underwent magnetic resonance imaging of the cervical spine, and 542 of these (90%) showed presence of a narrow spinal canal. It was important to measure the anteroposterior diameter of the spinal canal in each case and to have an accurate diagnosis based on diagnostic criteria. Dizziness and/or vertigo develop because of long-term, inappropriate neck posture in the presence of some kind of cervical disease. Triggers of dizziness and/or vertigo were different in men and women and in each generation. In elderly women, the characteristic trigger was long-term farming, gardening, weeding. About 79% of the cases were accompanied by stiff neck and shoulder; therefore, selection of appropriate muscle relaxants at appropriate doses as well as proper advice to patients regarding neck posture and lifestyle are very important in the treatment of cervicogenic dizziness. The results of this study emphasize the importance of cervicogenic dizziness as a cause of dizziness and/or vertigo that are difficult to cure. Dept. of Neurosurgery, Takahashi Neurosurgery and Dermatology Clinic, Niigata, Japan