{"id":6957,"date":"2023-09-01T12:00:41","date_gmt":"2023-09-01T03:00:41","guid":{"rendered":"https:\/\/wp.meccari.jp\/?p=6957"},"modified":"2023-12-25T12:17:28","modified_gmt":"2023-12-25T03:17:28","slug":"menu_54","status":"publish","type":"post","link":"https:\/\/wp.meccari.jp\/eigocafe\/menu_54\/","title":{"rendered":"Menu 54\u3000\u3081\u307e\u3044\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe"},"content":{"rendered":"

\"\"<\/p>\r\n\r\n

\u3053\u3093\u306b\u3061\u306f\u3002\u300c\u533b\u5b66\u82f1\u8a9e\u30ab\u30d5\u30a7<\/strong><\/span>\u300d\u306b\u3088\u3046\u3053\u305d\uff01<\/span><\/p>\r\n

\u3053\u3053\u306f\u300c\u30b3\u30fc\u30d2\u30fc1\u676f\u5206\u300d\u306e\u6642\u9593\u3067\u3001\u533b\u5b66\u82f1\u8a9e\u306b\u307e\u3064\u308f\u308b\u8a71\u3092\u6c17\u8efd\u306b\u697d\u3057\u3093\u3067\u3044\u305f\u3060\u304f\u30b3\u30fc\u30ca\u30fc\u3067\u3059\u3002<\/span><\/p>\r\n

\u672c\u65e5\u306e\u30c6\u30fc\u30de\u306f\u300c\u3081\u307e\u3044\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe<\/strong><\/span>\u300d\u3002<\/span><\/p>\r\n

\u300c\u3081\u307e\u3044<\/strong>\u300d\u306e\u8a3a\u5bdf\u3068\u805e\u3044\u3066\u3001\u300c\u305d\u308c\u3001\u5f97\u610f\u306a\u75c7\u72b6\u3067\u3059\uff01<\/strong>\u300d\u3068\u8a00\u3044\u5207\u308c\u308b\u533b\u5b66\u751f\u3084\u533b\u5e2b\u306f\u5c11\u306a\u3044\u306e\u3067\u306f\u306a\u3044\u3067\u3057\u3087\u3046\u304b\uff1f\u3081\u307e\u3044\u306e\u82f1\u8a9e\u8868\u73fe\u306f\u591a\u5c90\u306b\u6e21\u308a\u307e\u3059\u3057\u3001HINTS \u3084 Dix-Hallpike test \u306a\u3069\u3001\u540d\u524d\u3092\u805e\u304f\u3060\u3051\u3067\u3082\u300c\u3081\u307e\u3044<\/strong>\u300d\u304c\u751f\u3058\u308b\u3088\u3046\u306a\u8a3a\u5bdf\u3082\u5b58\u5728\u3057\u307e\u3059\u3002<\/span><\/p>\r\n

\u305d\u3053\u3067\u4eca\u56de\u306f\u3053\u306e\u96e3\u3057\u3044\u300c\u3081\u307e\u3044<\/strong>\u300d\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe\u3092\u3054\u7d39\u4ecb\u3057\u307e\u3059\u3002<\/span><\/p>\r\n

\u305d\u3082\u305d\u3082 dizziness \u3063\u3066\u4f55\uff1f<\/strong><\/span><\/span>
\r\n\u307e\u305a\u306f\u300c\u3081\u307e\u3044<\/strong>\u300ddizziness<\/strong><\/span> \u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe\u3092\u78ba\u8a8d\u3057\u307e\u3057\u3087\u3046\u3002<\/span><\/p>\r\n

\u300c\u3081\u307e\u3044<\/strong>\u300d\u304c\u3042\u308b\u5834\u5408\u3001\u60a3\u8005\u3055\u3093\u306f\u540d\u8a5e\u3092\u4f7f\u3063\u3066 \u201cI have dizziness<\/strong><\/span>.\u201d \u306e\u3088\u3046\u306b\u8868\u73fe\u3057\u305f\u308a\u3001\u5f62\u5bb9\u8a5e\u3092\u4f7f\u3063\u3066 \u201cI feel dizzy<\/strong><\/span>.\u201d \u306e\u3088\u3046\u306b\u8868\u73fe\u3057\u307e\u3059\u3002<\/span><\/p>\r\n

\u3067\u306f\u3001\u305d\u3082\u305d\u3082\u3053\u306e\u300c\u3081\u307e\u3044<\/strong>\u300ddizziness<\/strong> \u3068\u306f\u4f55\u306a\u306e\u3067\u3057\u3087\u3046\uff1f<\/span><\/p>\r\n

dizziness \u306e\u5b9a\u7fa9\u306f disturbed balance or spatial orientation<\/strong><\/span> \u3067\u3059\u3002\u305f\u3060\u3053\u308c\u3060\u3051\u3060\u3068\u3088\u304f\u308f\u304b\u3089\u306a\u3044\u306e\u3067\u3001\u4e00\u822c\u7684\u306b\u306f\u4e0b\u8a18\u306e4\u3064\u306e\u75c7\u72b6<\/strong>\u3092\u7dcf\u79f0\u3057\u3066 dizziness \u3068\u547c\u3093\u3067\u3044\u307e\u3059\u3002<\/span><\/p>\r\n

\u2022\u3000<\/em>Vertigo: \u201cspinning\u201d<\/strong><\/span>
\r\n\u2022\u3000<\/em>Pre-syncope: \u201clightheadedness\u201d<\/strong><\/span>
\r\n\u2022\u3000<\/em>Disequilibrium: \u201closs of balance\u201d<\/strong><\/span>
\r\n\u2022\u3000<\/em>Non-specific dizziness: \u201cgiddiness\u201d<\/strong><\/span><\/p>\r\n

\u60a3\u8005\u3055\u3093\u304c spinning<\/strong><\/span> \u306a\u3069\u3068\u3044\u3046\u8868\u73fe\u3092\u4f7f\u3063\u3066 \u201cI feel the room is spinning<\/strong>.\u201d \u3084 \u201cI feel I\u2019m spinning<\/strong> in the room.\u201d \u306a\u3069\u3068\u8868\u73fe\u3059\u308b\u5834\u5408\u3001\u305d\u306e dizziness \u306f vertigo<\/strong><\/span>\u300c\u56de\u8ee2\u6027\u3081\u307e\u3044\u300d\u3068\u306a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n

\u6b21\u306b\u60a3\u8005\u3055\u3093\u304c lightheadedness<\/strong><\/span>\/lightheaded<\/strong><\/span> \u3068\u3044\u3046\u8868\u73fe\u3092\u4f7f\u3063\u3066 \u201cI have lightheadedness<\/strong>.\u201d \u3084 \u201cI feel lightheaded<\/strong>.\u201d \u306a\u3069\u3068\u8868\u73fe\u3059\u308b\u5834\u5408\u3001\u305d\u306e dizziness \u306f syncope<\/strong><\/span><\/a>\u300c\u5931\u795e<\/strong>\u300d\u306e prodrome symptom<\/strong>\u300c\u524d\u99c6\u75c7\u72b6<\/strong>\u300d\u3068\u3057\u3066\u306e pre-syncope<\/strong><\/span>\/presyncope<\/strong><\/span>\u300c\u524d\u5931\u795e<\/strong>\u300d\u3068\u306a\u308a\u307e\u3059\u3002\u305d\u3057\u3066 pre-syncope \u306e\u5834\u5408\u3001 \u3053\u306e lightheadedness \u3068\u3044\u3046\u8868\u73fe\u4ee5\u5916\u306b\u3082\u3001\u60a3\u8005\u3055\u3093\u306f\u300c\u6c17\u304c\u9060\u304f\u306a\u308b<\/strong>\u300d\u300c\u610f\u8b58\u3092\u5931\u3044\u305d\u3046\u306b\u306a\u308b<\/strong>\u300d\u3068\u3044\u3046\u610f\u5473\u3067 \u201cI was going to faint<\/strong>\/pass out<\/strong>.\u201d \u3084 \u201cI was about to faint<\/strong>\/pass out<\/strong>.\u201d \u306e\u3088\u3046\u306a\u8868\u73fe\u3082\u4f7f\u3044\u307e\u3059\u3002<\/span><\/p>\r\n

\u60a3\u8005\u3055\u3093\u304c\u4f7f\u3046\u8868\u73fe\u304c\u3042\u308b\u7a0b\u5ea6\u9650\u3089\u308c\u3066\u3044\u308b vertigo \u3068 pre-syncope \u306b\u5bfe\u3057\u3001\u300c\u5e73\u8861\u969c\u5bb3<\/strong>\u300d\u3067\u3042\u308b disequilibrium<\/strong><\/span> \u306b\u306f\u6570\u591a\u304f\u306e\u82f1\u8a9e\u8868\u73fe\u304c\u4f7f\u308f\u308c\u307e\u3059\u3002\u5e73\u8861\u611f\u899a\u306b\u7570\u5e38\u304c\u751f\u3058\u308b\u306e\u3067\u3001\u60a3\u8005\u3055\u3093\u306f loss of balance<\/strong> \u3084 imbalance<\/strong> \u306a\u3069\u306e\u8868\u73fe\u3092\u4f7f\u3044\u307e\u3059\u3057\u3001\u300c\u8db3\u5143\u304c\u304a\u307c\u3064\u304b\u306a\u3044<\/strong>\u300d\u3068\u3044\u3046\u30a4\u30e1\u30fc\u30b8\u3067 unsteadiness<\/strong> \u3084 instability<\/strong> \u306a\u3069\u3082\u4f7f\u3044\u307e\u3059\u3002\u60a3\u8005\u3055\u3093\u306f ataxia<\/strong>\u300c\u904b\u52d5\u5931\u8abf<\/strong>\u300d\u3082\u4f34\u3063\u305f\u300c\u9154\u3063\u6255\u3063\u3066\u3044\u308b\u3088\u3046\u306a\u611f\u899a<\/strong>\u300d\u3082\u899a\u3048\u308b\u305f\u3081\u3001feeling of drunkenness<\/strong> \u3084 swaying<\/strong> \u306a\u3069\u306e\u8868\u73fe\u3082\u4f7f\u308f\u308c\u307e\u3059\u3002\u307e\u305f di<\/strong>sequilibrium \u306f dy<\/strong>sequilibrium \u3068\u3044\u3046\u30b9\u30da\u30eb\u3067\u8a18\u8ff0\u3055\u308c\u308b\u5834\u5408\u3082\u3042\u308a\u307e\u3059\u3002<\/span><\/p>\r\n

\u3053\u308c\u3089 vertigo, pre-syncope, and disequilibrium 3\u3064\u306e\u3044\u305a\u308c\u306b\u3082\u5206\u985e\u3055\u308c\u306a\u3044 dizziness\u3063\u307d\u3044\u75c7\u72b6\u3092 non-specific dizziness<\/strong> \u3068\u547c\u79f0\u3057\u307e\u3059\u3002\u305d\u3057\u3066\u3053\u306e non-specific dizziness \u306b\u306f giddiness<\/strong>\/giddy<\/strong>\u300c\u30af\u30e9\u30af\u30e9\u3059\u308b<\/strong>\u300d\u3084 wooziness<\/strong>\/woozy<\/strong>\u300c\u30d5\u30e9\u30d5\u30e9\u3059\u308b<\/strong>\u300d\u306e\u3088\u3046\u306a\u591a\u5f69\u306a\u82f1\u8a9e\u8868\u73fe\u304c\u4f7f\u308f\u308c\u307e\u3059\u3002<\/span><\/p>\r\n

\u3055\u3089\u306b\u8a71\u3092\u3084\u3084\u3053\u3057\u304f\u3057\u3066\u3044\u308b\u306e\u304c\u3001\u533b\u5e2b\u306b\u3088\u3063\u3066\u306f pre-syncope \u3092 lightheadedness \u3068\u547c\u3070\u305a\u3001non-specific dizziness \u3092 lightheadedness \u3068\u547c\u3076\u5834\u5408\u304c\u3042\u308b<\/strong>\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u3053\u306e\u5834\u5408\u3001dizziness \u306f\u4e0b\u8a18\u306e4\u3064\u306e\u75c7\u72b6\u306e\u7dcf\u79f0\u3068\u306a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n

\u2022\u3000<\/em><\/strong>Vertigo<\/span>
\r\n\u2022\u3000<\/em><\/strong>Pre-syncope<\/span>
\r\n\u2022\u3000<\/em><\/strong>Disequilibrium<\/span>
\r\n\u2022\u3000<\/em>Lightheadedness<\/strong><\/span><\/p>\r\n

\u4ee5\u4e0a\u304c dizziness \u306e\u5b9a\u7fa9\u306b\u95a2\u3059\u308b\u304a\u8a71\u3067\u3059\u3002\u3069\u3046\u3067\u3059\uff1f\u3053\u308c\u3060\u3051\u3067 \u201cI feel dizzy.\u201d \u3068\u306a\u3063\u305f\u65b9\u3082\u3044\u308b\u306e\u3067\u306f\u306a\u3044\u3067\u3057\u3087\u3046\u304b\uff1f<\/span><\/p>\r\n

\u3069\u3046\u8003\u3048\u308c\u3070\u3044\u3044\u306e\uff1f\u3081\u307e\u3044\u306e\u8a3a\u65ad<\/strong><\/span><\/span>
\r\n\u3081\u307e\u3044\u306e\u8a3a\u65ad\u306b\u95a2\u3057\u3066\u3001\u5f93\u6765\u306e\u533b\u5b66\u6559\u80b2\u3067\u306f\u60a3\u8005\u3055\u3093\u304c\u8a34\u3048\u308b\u3081\u307e\u3044\u3092\u4e0b\u8a18\u306e4\u3064\u306b\u5206\u985e\u3057\u3001\u305d\u308c\u305e\u308c\u306e\u9451\u5225\u75be\u60a3\u3092\u8003\u3048\u3066\u3044\u304f\u3068\u6559\u3048\u3066\u3044\u307e\u3057\u305f\u3002<\/span><\/p>\r\n

\u2022\u3000<\/em>Vertigo<\/strong><\/span>
\r\n\u2022\u3000<\/em>Pre-syncope<\/strong><\/span>
\r\n\u2022\u3000<\/em>Disequilibrium<\/strong><\/span>
\r\n\u2022\u3000<\/em>Non-specific dizziness<\/strong><\/span><\/p>\r\n

\u3064\u307e\u308a\u60a3\u8005\u3055\u3093\u304c \u201cI have dizziness.\u201d \u3084 \u201cI feel dizzy.\u201d \u3068\u8a34\u3048\u305f\u5834\u5408\u3001\u201cCould you describe the sensation without using the word dizziness or dizzy?<\/strong>\u201d \u3068\u5c0b\u306d\u3066\u3001\u305d\u306e dizziness \u304c\u4e0a\u8a184\u3064\u306e\u7a2e\u985e\u306e\u3069\u308c\u306b\u5206\u985e\u3055\u308c\u308b\u306e\u304b\u3092\u78ba\u8a8d\u3057\u3001\u305d\u3053\u304b\u3089\u9451\u5225\u75be\u60a3\u3092\u8003\u3048\u3066\u3044\u304f\u3068\u3044\u3046\u65b9\u6cd5\u3067\u3059\u3002<\/span><\/p>\r\n

\u305f\u3060\u3053\u306e symptom quality \u3084 type of dizziness \u3068\u547c\u3070\u308c\u308b\u60a3\u8005\u3055\u3093\u304b\u3089\u306e\u60c5\u5831\u306f\u3001\u300c\u8a3a\u65ad\u3067\u7528\u3044\u308b\u306b\u306f\u3042\u307e\u308a\u4fe1\u7528\u3067\u304d\u306a\u3044<\/strong>\u300d\u3068\u3044\u3046\u306e\u304c\u554f\u984c\u306b\u306a\u308a\u307e\u3059\u3002\u3068\u8a00\u3046\u306e\u3082\u672c\u6765\u306a\u3089 pre-syncope \u3092\u5f15\u304d\u8d77\u3053\u3059\u75be\u60a3\u306a\u306e\u306b\u3001\u60a3\u8005\u3055\u3093\u306f\u81ea\u5206\u306e dizziness \u3092 vertigo \u306e\u3088\u3046\u306b\u8868\u73fe\u3057\u305f\u308a\u3001\u9006\u306b\u672c\u6765\u306a\u3089 vertigo \u3092\u5f15\u304d\u8d77\u3053\u3059\u75be\u60a3\u306a\u306e\u306b\u3001\u60a3\u8005\u3055\u3093\u306f pre-syncope \u306e\u3088\u3046\u306b\u8868\u73fe\u3059\u308b\u5834\u5408\u3082\u3042\u308b\u304b\u3089\u3067\u3059\u3002<\/span><\/p>\r\n

\u305d\u3053\u3067\u3053\u306e\u5f93\u6765\u578b\u306e symptom quality\/type of dizziness \u306e\u30a2\u30d7\u30ed\u30fc\u30c1\u6cd5\u306b\u4ee3\u308f\u3063\u3066\u63d0\u5531\u3055\u308c\u3066\u3044\u308b\u306e\u304c\u3001New Diagnostic Approach to the Adult Patient with Acute Dizziness<\/strong><\/span><\/a> \u3067\u7d39\u4ecb\u3055\u308c\u3066\u3044\u308b ATTEST<\/strong><\/span> \u3068\u3044\u3046\u30a2\u30d7\u30ed\u30fc\u30c1\u6cd5\u3067\u3059\u3002\u82f1\u8a9e\u306e attest<\/strong> \u306b\u306f\u300c\u8a3c\u660e<\/strong>\u300d\u3084\u300c\u8a3c\u660e\u3059\u308b<\/strong>\u300d\u3068\u3044\u3046\u610f\u5473\u304c\u3042\u308b\u306e\u3067\u3059\u304c\u3001\u3053\u3053\u3067\u306f\u4e0b\u8a18\u306e\u9805\u76ee\u306e\u982d\u6587\u5b57\u3068\u306a\u3063\u3066\u3044\u307e\u3059\u3002<\/span><\/p>\r\n

ATTEST<\/strong><\/span><\/span>
\r\nA<\/strong>: A<\/strong><\/span>ssociated symptoms<\/span>
\r\nTT<\/strong>: T<\/strong><\/span>iming and T<\/strong><\/span>riggers<\/span>
\r\nES<\/strong>: E<\/strong><\/span>xamination S<\/strong><\/span>igns<\/span>
\r\nT<\/strong>: additional T<\/strong><\/span>esting as needed<\/span><\/p>\r\n

\u3053\u306e\u30a2\u30d7\u30ed\u30fc\u30c1\u6cd5\u306e\u8a73\u7d30\u306f\u5f8c\u8ff0\u3057\u307e\u3059\u304c\u3001\u3053\u3053\u3067\u306e\u30dd\u30a4\u30f3\u30c8\u306f Associated symptoms<\/strong><\/span>\u300c\u3081\u307e\u3044\u306e\u968f\u4f34\u75c7\u72b6<\/strong>\u300d\u306e\u6709\u7121\u3068\u3001 Timing<\/strong><\/span> and<\/strong> Triggers<\/strong><\/span>\u300c\u3081\u307e\u3044\u306e\u30bf\u30a4\u30df\u30f3\u30b0\u3068\u30c8\u30ea\u30ac\u30fc<\/strong>\u300d\u304c\u8a3a\u65ad\u306b\u304a\u3044\u3066\u91cd\u8981\u306b\u306a\u308b\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002<\/span><\/p>\r\n

\u6570\u591a\u304f\u306e\u75c7\u72b6\u306e\u8a3a\u65ad\u3092\u8eab\u306b\u3064\u3051\u306a\u3051\u308c\u3070\u3044\u3051\u306a\u3044\u533b\u5b66\u751f\u306b\u3068\u3063\u3066\u3001\u305d\u308c\u305e\u308c\u306e\u75c7\u72b6\u3067\u8a3a\u65ad\u306e\u30a2\u30d7\u30ed\u30fc\u30c1\u3092\u30b3\u30ed\u30b3\u30ed\u3068\u5909\u3048\u3066\u3057\u307e\u3046\u3068\u3001\u8ca0\u8377\u3092\u611f\u3058\u3066\u8a3a\u65ad\u306b\u82e6\u624b\u610f\u8b58\u3092\u6301\u3064\u306e\u3067\u306f\u3068\u500b\u4eba\u7684\u306b\u5371\u60e7\u3057\u3066\u3044\u307e\u3059\u3002\u3057\u304b\u3057\u3053\u306e\u300c\u533b\u5b66\u82f1\u8a9e\u30ab\u30d5\u30a7<\/strong>\u300d\u3067\u7e70\u308a\u8fd4\u3057\u5f37\u8abf\u3057\u3066\u3044\u308b\u3088\u3046\u306b\u3001History of Present Illness (HPI)<\/strong>\u300c\u73fe\u75c5\u6b74<\/strong>\u300d\u3092\u4e01\u5be7\u306b\u5c0b\u306d\u308b\u3053\u3068\u3067\u3053\u306e A + TT \u306e\u90e8\u5206\u3082\u3057\u3063\u304b\u308a\u3068\u30ab\u30d0\u30fc\u3067\u304d\u308b\u306e\u3067\u3059\u3002\u3053\u3061\u3089<\/strong><\/span><\/a>\u3067\u3082\u7d39\u4ecb\u3057\u3066\u3044\u308b\u3088\u3046\u306b\u3001\u3069\u3093\u306a\u75c7\u72b6\u306e\u5834\u5408\u3067\u3082 HPI \u306b\u95a2\u3057\u3066\u306f\u4e0b\u8a18\u306e3\u3064\u306e\u30b9\u30c6\u30c3\u30d7\u3067\u5c0b\u306d\u3066\u3044\u304d\u307e\u3057\u3087\u3046\u3002<\/span><\/p>\r\n

1.\u3000<\/em>Open-ended questions<\/strong>: \u958b\u653e\u578b\u8cea\u554f\u3092\u4f7f\u3044\u300c\u767a\u75c7<\/strong>\u300d\u300c\u767a\u75c7\u524d<\/strong>\u300d\u300c\u767a\u75c7\u5f8c<\/strong>\u300d\u306e\u69d8\u5b50\u3092\u8a73\u7d30\u306b\u8a9e\u3063\u3066\u3082\u3089\u3046\u3002\u72b6\u6cc1\u306b\u5408\u308f\u305b\u3066\u8cea\u554f\u3092\u52a0\u3048\u3001\u9069\u5b9c\u8a71\u3092\u8981\u7d04\u3059\u308b\u3002<\/span>
\r\n2.\u3000<\/em>Closed-ended questions<\/strong>: \u201cpain\u2019s OPQRST\u201d \u3084 \u201cSOCRATES\u201d \u306a\u3069\u3092\u30c1\u30a7\u30c3\u30af\u30ea\u30b9\u30c8\u3068\u3057\u3066\u4f7f\u3044\u3001 \u805e\u304d\u6f0f\u3089\u3057\u304c\u306a\u3044\u304b\u78ba\u8a8d\u3059\u308b\u3002<\/span>
\r\n3.\u3000<\/em>Associated symptoms<\/strong>: \u9451\u5225\u75be\u60a3\u306b\u4f34\u3046\u95a2\u9023\u75c7\u72b6\u306e\u6709\u7121\u3092\u5c0b\u306d\u308b\u3002<\/span><\/p>\r\n

\u3053\u3046\u3059\u308c\u3070 Open-ended questions \u3068 Closed-ended questions \u306b\u3066 Timing & Triggers \u306e\u60c5\u5831\u304c\u5f97\u3089\u308c\u307e\u3059\u3057\u3001Associated symptoms \u3082\u533b\u7642\u9762\u63a5\u306e\u65e9\u3044\u6bb5\u968e\u3067\u5c0b\u306d\u308b\u3053\u3068\u304c\u3067\u304d\u307e\u3059\u3002\u3053\u306e\u3088\u3046\u306b\u300c\u57fa\u672c\u3092\u5fb9\u5e95\u3059\u308b<\/strong>\u300d\u3053\u3068\u3092\u610f\u8b58\u3059\u308c\u3070\u3001dizziness \u306e\u3088\u3046\u306a\u8a3a\u65ad\u304c\u96e3\u3057\u3044\u75c7\u72b6\u306b\u3082\u5fdc\u7528\u3059\u308b\u3053\u3068\u304c\u53ef\u80fd\u3068\u306a\u308b\u306e\u3067\u3059\u3002<\/span><\/p>\r\n

\u3053\u306e\u57fa\u672c\u3092\u5fb9\u5e95\u3059\u308b\u3068\u3057\u3066\u3001\u7279\u306b dizziness \u306e HPI \u3067\u306f Associated symptoms<\/strong> \u3068 Timing<\/strong> & Triggers<\/strong> \u306e3\u3064\u3092\u91cd\u8996\u3057\u3066\u8cea\u554f\u3059\u308b\u3088\u3046\u306b\u3057\u307e\u3057\u3087\u3046\u3002<\/span><\/p>\r\n

\u2022\u3000<\/em>Associated symptoms<\/strong>: Do you have any other symptoms?<\/span>
\r\n\u2022\u3000<\/em>Timing<\/strong>: Is the dizziness continuously present now?<\/span>
\r\n\u2022\u3000<\/em>Triggers<\/strong>: Can anything trigger your dizziness?<\/span><\/p>\r\n

\u3069\u3093\u306a\u75c5\u6c17\u304c\u3042\u308b\uff1f\u3081\u307e\u3044\u306e\u9451\u5225\u75be\u60a3<\/strong><\/span><\/span>
\r\n\u3067\u306f dizziness \u306e\u9451\u5225\u75be\u60a3\u306b\u306f\u3069\u306e\u3088\u3046\u306a\u3082\u306e\u304c\u3042\u308b\u306e\u3067\u3057\u3087\u3046\u304b\uff1f\u3053\u3053\u3067\u306f\u5148\u307b\u3069\u306e ATTEST<\/strong><\/span> \u306e\u30a2\u30d7\u30ed\u30fc\u30c1\u6cd5\u3092\u4f7f\u3063\u3066 dizziness \u306e\u9451\u5225\u75be\u60a3\u3092\u8003\u3048\u3066\u3044\u304d\u307e\u3057\u3087\u3046\u3002<\/span><\/p>\r\n

\u307e\u305a\u306f A<\/strong>ssociated symptoms \u306b\u7740\u76ee\u3057\u3001\u305d\u306e dizziness \u304c general medical cause \u306b\u3088\u3063\u3066\u5f15\u304d\u8d77\u3053\u3055\u308c\u3066\u3044\u308b\u304b\u3092\u78ba\u8a8d\u3057\u307e\u3059\u3002<\/span><\/p>\r\n

\u3053\u308c\u3082\u3053\u306e\u300c\u533b\u5b66\u82f1\u8a9e\u30ab\u30d5\u30a7\u300d\u3067\u306f\u7e70\u308a\u8fd4\u3057\u4f1d\u3048\u3066\u3044\u307e\u3059\u304c\u3001\u795e\u7d4c\u75c7\u72b6\u306b\u5bfe\u3057\u3066\u306f\u3069\u3093\u306a\u5834\u5408\u3067\u3082\u4e0b\u8a18\u306e4\u3064\u306e Red Flags<\/strong><\/span> \u300c\u5371\u967a\u306a\u75be\u60a3<\/strong><\/span>\u300d\u3092\u8003\u3048\u3066\u3001\u305d\u306e\u968f\u4f34\u75c7\u72b6\u3092\u5c0b\u306d\u308b\u3088\u3046\u306b\u3057\u307e\u3057\u3087\u3046\u3002<\/span><\/p>\r\n

\u2022\u3000<\/em><\/strong>Stroke \u300c\u8133\u5352\u4e2d\u300d<\/span>
\r\n\u2022\u3000<\/em><\/strong>Meningitis \u300c\u9ac4\u819c\u708e\u300d<\/span>
\r\n\u2022\u3000<\/em><\/strong>Intoxication\u300c\uff08\u85ac\u7269\u3084\u30a2\u30eb\u30b3\u30fc\u30eb\u306a\u3069\u306e\uff09\u4e2d\u6bd2\u300d<\/span>
\r\n\u2022\u3000<\/em><\/strong>Metabolic conditions\u300c\u4ee3\u8b1d\u6027\u75be\u60a3\u300d<\/span><\/p>\r\n

\u3053\u306e\u3088\u3046\u306b associated symptoms \u3092\u5c0b\u306d\u3066\u3001\u305d\u3053\u3067\u4e0a\u8a18\u306e\u3088\u3046\u306a\u75be\u60a3\u304c\u9664\u5916\u3055\u308c\u305f\u3082\u306e\u3092\u300c\u524d\u5ead\u304c\u539f\u56e0\u3067\u8d77\u3053\u308b\u75c5\u6c17\u3063\u307d\u3044<\/strong>\u300d\u3068\u3044\u3046\u3053\u3068\u3067 vestibular syndrome<\/strong><\/span> \u3068\u547c\u3073\u307e\u3059\u3002<\/span><\/p>\r\n

\u6b21\u306b T<\/strong>iming \u306b\u7740\u76ee\u3057\u3066\u3001\u3053\u306e vestibular syndrome \u3092\u8a73\u3057\u304f\u5206\u985e\u3057\u3066\u3044\u304d\u307e\u3059\u3002<\/span><\/p>\r\n

\u8a3a\u5bdf\u6642\u306b\u3082 dizziness \u304c\u3042\u308b\u5834\u5408<\/strong>\u3001\u305d\u308c\u3092 acute vestibular syndrome (AVS)<\/strong><\/span> \u3068\u547c\u3073\u3001\u305d\u3053\u304b\u3089\u3055\u3089\u306b\u8a3a\u65ad\u3092\u9032\u3081\u3066\u3044\u304d\u307e\u3059\u3002<\/span><\/p>\r\n

\u8a3a\u5bdf\u6642\u306b dizziness \u304c\u306a\u3044\u5834\u5408<\/strong>\u3001\u305d\u308c\u3092 episodic vestibular syndrome (EVS)<\/strong><\/span> \u3068\u547c\u3073\u3001\u305d\u3053\u304b\u3089\u3055\u3089\u306b\u8a3a\u65ad\u3092\u9032\u3081\u3066\u3044\u304d\u307e\u3059\u3002<\/span><\/p>\r\n

\u305d\u3057\u3066\u3053\u306e AVS \u3068 EVS \u3092\u305d\u308c\u305e\u308c\u306e T<\/strong>riggers \u306b\u7740\u76ee\u3057\u3001\u30c8\u30ea\u30ac\u30fc\u306e\u3042\u308b\u5834\u5408<\/strong>\u3068\u30c8\u30ea\u30ac\u30fc\u306e\u306a\u3044\u5834\u5408<\/strong>\u3067\u8003\u3048\u3066\u3044\u304d\u307e\u3059\u3002<\/span><\/p>\r\n

\u30c8\u30ea\u30ac\u30fc\u306e\u3042\u308b AVS \u306e\u5834\u5408\u3001\u591a\u304f\u306f trauma \u3084 medications \u306a\u3069\u306b\u3088\u308b AVS \u3067\u3042\u308a\u3001\u3053\u308c\u3089\u306f\u5148\u307b\u3069\u306e associated symptoms \u306e\u8cea\u554f\u306b\u3066\u65e2\u306b\u9664\u5916\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u554f\u984c\u306a\u306e\u306f\u30c8\u30ea\u30ac\u30fc\u306e\u306a\u3044 AVS<\/strong> \u3067\u3042\u308a\u3001\u3053\u3053\u304b\u3089\u306f\u3053\u308c\u3092 AVS<\/strong> \u3068\u3057\u3066\u8a3a\u65ad\u3092\u9032\u3081\u3066\u3044\u304d\u307e\u3059\u3002<\/span><\/p>\r\n

EVS \u3067\u306f\u30c8\u30ea\u30ac\u30fc\u306e\u3042\u308b EVS<\/strong> \u3068\u30c8\u30ea\u30ac\u30fc\u306e\u306a\u3044 EVS<\/strong> \u3092\u305d\u308c\u305e\u308c triggerable EVS (t-EVS)<\/strong><\/span> \u3068 spontaneous EVS (s-EVS)<\/strong><\/span> \u3068\u547c\u79f0\u3057\u3001\u305d\u3053\u304b\u3089\u3055\u3089\u306b\u8a3a\u65ad\u3092\u9032\u3081\u3066\u3044\u304d\u307e\u3059\u3002<\/span><\/p>\r\n

\u3064\u307e\u308a Timing & Triggers \u306e2\u3064\u306e\u9805\u76ee\u306b\u3088\u3063\u3066\u3001dizziness \u306e\u539f\u56e0\u306f\u4e0b\u8a18\u306e3\u3064\u306b\u5206\u985e\u3055\u308c\u308b\u306e\u3067\u3059\u3002<\/span><\/p>\r\n

\u2022\u3000<\/em>(spontaneous) acute vestibular syndrome (AVS<\/strong><\/span>)<\/strong><\/span>
\r\n\u2022\u3000<\/em>triggerable episodic vestibular syndrome (t-EVS<\/strong><\/span>)<\/strong><\/span>
\r\n\u2022\u3000<\/em>spontaneous episodic vestibular syndrome (s-EVS<\/strong><\/span>)<\/strong><\/span><\/p>\r\n

\u3053\u3053\u304b\u3089 ATTEST \u306e\u30a2\u30d7\u30ed\u30fc\u30c1\u6cd5\u306e E<\/strong>xamination S<\/strong>igns \u3067\u3042\u308b physical exam \u3092\u4f7f\u3063\u3066\u3055\u3089\u306b\u8a3a\u65ad\u3092\u9032\u3081\u308b\u306e\u3067\u3059\u304c\u3001\u307e\u305a\u306f\u305d\u308c\u305e\u308c\u306e\u4ee3\u8868\u7684\u306a\u9451\u5225\u75be\u60a3\u3092\u793a\u3057\u3066\u304a\u304d\u307e\u3057\u3087\u3046\u3002<\/span><\/p>\r\n

\u2022\u3000<\/em><\/strong>AVS<\/strong><\/span>\u306e\u9451\u5225\u75be\u60a3: vestibular neuritis<\/strong><\/span> or posterior circulation stroke<\/strong><\/span><\/span>
\r\n\u2022\u3000<\/em><\/strong>t-EVS<\/strong><\/span> \u306e\u9451\u5225\u75be\u60a3: BPPV<\/strong><\/span> or orthostatic hypotension<\/strong><\/span><\/span>
\r\n\u2022\u3000<\/em><\/strong>s-EVS<\/strong><\/span> \u306e\u9451\u5225\u75be\u60a3: vestibular migraine<\/strong><\/span>, Meni\u00e8re’s disease<\/strong><\/span> or TIA<\/strong><\/span><\/span><\/p>\r\n

\u8a3a\u5bdf\u6642\u306b\u3082 dizziness \u304c\u7d9a\u3044\u3066\u3044\u308b acute vestibular syndrome (AVS)<\/strong> \u306e\u5834\u5408\u3001peripheral vertigo<\/strong> \u3068\u3082\u547c\u3070\u308c\u308b vestibular neuritis<\/strong><\/span>\u300c\u524d\u5ead\u795e\u7d4c\u708e<\/strong>\u300d\u304b\u3001central vertigo<\/strong> \u3068\u3082\u547c\u3070\u308c\u308b posterior circulation stroke<\/strong><\/span>\u300c\u690e\u9aa8\u52d5\u8108\u306e\u8133\u5352\u4e2d<\/strong>\u300d\u3092\u8003\u3048\u307e\u3059\u3002<\/span><\/p>\r\n

\u8a3a\u5bdf\u6642\u306b dizziness \u304c\u306a\u3044 episodic vestibular syndrome (EVS)<\/strong> \u306e\u5834\u5408\u3001\u30c8\u30ea\u30ac\u30fc\u306e\u3042\u308b t-EVS<\/strong> \u3067\u306f benign paroxysmal positional vertigo (BPPV)<\/strong><\/span>\u300c\u826f\u6027\u767a\u4f5c\u6027\u982d\u4f4d\u3081\u307e\u3044\u75c7<\/strong>\u300d\u304b\u3001orthostatic hypotension<\/strong><\/span>\u300c\u8d77\u7acb\u6027\u4f4e\u8840\u5727<\/strong>\u300d\u3092\u8003\u3048\u307e\u3059\u3002<\/span><\/p>\r\n

\u305d\u3057\u3066\u30c8\u30ea\u30ac\u30fc\u306e\u306a\u3044 s-EVS<\/strong> \u3067\u306f vestibular migraine<\/strong><\/span>\u300c\u524d\u5ead\u6027\u504f\u982d\u75db<\/strong>\u300d\u3084 Meni\u00e8re’s disease<\/strong><\/span>\u300c\u30e1\u30cb\u30a8\u30fc\u30eb\u75c5<\/strong>\u300d\u3001\u305d\u3057\u3066 transient ischemic attack (TIA)<\/strong><\/span>\u300c\u4e00\u904e\u6027\u8133\u865a\u8840\u767a\u4f5c<\/strong>\u300d\u3092\u8003\u3048\u307e\u3059\u3002<\/span><\/p>\r\n

\u4ee5\u4e0a\u3092\u3084\u3084\u4e71\u66b4\u306b\u307e\u3068\u3081\u308b\u3068\u3001dizziness \u306e\u8a3a\u65ad\u306e\u6d41\u308c\u306f\u4e0b\u8a18\u306e\u3088\u3046\u306b\u306a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n

1.\u3000<\/em>\u60a3\u8005\u3055\u3093\u304c dizziness \u3092\u8a34\u3048\u308b\u5834\u5408\u3001\u307e\u305a\u306f Red Flag<\/strong><\/span> \u306e\u6709\u7121\u3092\u78ba\u8a8d\u3059\u308b<\/span>
\r\n2.\u3000<\/em>\u8a3a\u5bdf\u6642\u306b\u3082 dizziness \u304c\u7d9a\u3044\u3066\u3044\u308b<\/strong>\u5834\u5408\u3001vestibular neuritis<\/strong> \u304b stroke<\/strong> \u304b\u3092\u9451\u5225\u3059\u308b<\/span>
\r\n3.\u3000<\/em>\u8a3a\u5bdf\u6642\u306b dizziness \u304c\u306a\u304f\u3066\u30c8\u30ea\u30ac\u30fc\u304c\u3042\u308b<\/strong>\u5834\u5408\u3001BPPV<\/strong> \u304b\u3069\u3046\u304b\u3092\u78ba\u8a8d\u3059\u308b<\/span>
\r\n4.\u3000<\/em>\u8a3a\u5bdf\u6642\u306b dizziness \u304c\u306a\u304f\u3066\u30c8\u30ea\u30ac\u30fc\u304c\u306a\u3044<\/strong>\u5834\u5408\u3001vestibular migraine<\/strong> \u3084 Meni\u00e8re’s disease<\/strong> \u306a\u3069\u3092\u8003\u3048\u308b<\/span><\/p>\r\n

HINTS? Dix-Hallpike test? \u96e3\u3057\u3044\u3081\u307e\u3044\u306e\u8a3a\u5bdf\u3092\u7406\u89e3\u3057\u3088\u3046\uff01<\/strong><\/span><\/span>
\r\n\u3053\u306e\u3088\u3046\u306b ATTEST \u306e\u30a2\u30d7\u30ed\u30fc\u30c1\u6cd5\u306e A<\/strong>ssociated symptoms \u3068 T<\/strong>iming and T<\/strong>riggers \u3092\u4f7f\u3048\u3070\u3001dizziness \u306e\u539f\u56e0\u3092\u4e0b\u8a18\u306e3\u3064\u306b\u5206\u985e\u3059\u308b\u3053\u3068\u304c\u53ef\u80fd\u306b\u306a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n

\u2022\u3000<\/em>AVS<\/strong>: vestibular neuritis<\/strong> or posterior circulation stroke<\/strong><\/span>
\r\n\u2022\u3000<\/em>t-EVS<\/strong>: BPPV<\/strong> or orthostatic hypotension<\/strong><\/span>
\r\n\u2022\u3000<\/em>s-EVS<\/strong>: vestibular migraine, Meni\u00e8re’s disease<\/strong> or TIA<\/strong><\/span><\/p>\r\n

\u3053\u306e\u3046\u3061\u4e0b\u8a18\u306e\u9451\u5225\u306f ATTEST \u306e E<\/strong>xamination S<\/strong>igns (ES<\/strong>) \u3067\u3042\u308b physical examination<\/strong> \u3067\u884c\u3046\u3053\u3068\u304c\u3067\u304d\u307e\u3059\u3002<\/span><\/p>\r\n

\u2022\u3000<\/em>vestibular neuritis<\/strong> (peripheral vertigo) vs posterior circulation stroke<\/strong> (central vertigo)<\/span>
\r\n\u2022\u3000<\/em>BPPV<\/strong> vs orthostatic hypotension<\/strong><\/span><\/p>\r\n

\u3067\u306f\u3001\u5177\u4f53\u7684\u306b\u3069\u306e\u3088\u3046\u306a\u8eab\u4f53\u8a3a\u5bdf\u3067 vestibular neuritis \u3068 stroke\u3092\u533a\u5225\u3057\u3001\u305d\u3057\u3066 BPPV \u304b\u3069\u3046\u304b\u3092\u78ba\u8a8d\u3059\u308b\u306e\u3067\u3057\u3087\u3046\u304b\uff1f<\/span><\/p>\r\n

\u307e\u305a\u672b\u68a2\u6027<\/strong>\u3067\u3042\u308b vestibular neuritis \u3068\u4e2d\u67a2\u6027<\/strong>\u3067\u3042\u308b stroke \u306e\u533a\u5225\u306b\u306f\u3001 HINTS exam<\/strong><\/span><\/a><\/span> \u3068\u547c\u3070\u308c\u308b physical exam \u3092\u7528\u3044\u307e\u3059\u3002<\/span><\/p>\r\n

\u3053\u306e HINTS \u306f H<\/strong><\/span>ead I<\/strong><\/span>mpulse, N<\/strong><\/span>ystagmus, and T<\/strong><\/span>est of S<\/strong><\/span>kew \u306e\u982d\u6587\u5b57\u3092\u53d6\u3063\u305f\u8868\u73fe\u3067\u3059\u3002\u305f\u3060\u5b9f\u969b\u306b\u8a3a\u5bdf\u3059\u308b\u969b\u306e\u9806\u5e8f\u306f HI\u2192N\u2192TS \u3067\u306f\u306a\u304f\u3001H<\/strong>ead I<\/strong>mpulse \u3092\u6700\u5f8c\u306b\u56de\u3059 N\u2192TS\u2192HI<\/strong> \u306e\u9806\u306b\u884c\u3044\u3001\u4e0b\u8a18\u306e\u9805\u76ee\u3092\u78ba\u8a8d\u3057\u307e\u3059\u3002<\/span><\/p>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
\u00a0<\/td>\r\nVestibular Neuritis<\/th>\r\nStroke<\/th>\r\n<\/tr>\r\n<\/thead>\r\n
Nystagmus<\/th>\r\nUnidirectional & Horizontal<\/td>\r\nBidirectional & Vertical<\/td>\r\n<\/tr>\r\n
Test of Skew<\/th>\r\nNo Vertical Skew<\/td>\r\nVertical Skew<\/td>\r\n<\/tr>\r\n
Head Impulse<\/th>\r\nCorrective Saccade<\/td>\r\nNo Corrective Saccade<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

\u307e\u305a\u78ba\u8a8d\u3059\u308b\u306e\u306f Nystagmus<\/strong><\/span>\u300c\u773c\u632f<\/strong>\u300d\u3067\u3059\u3002\u672b\u68a2\u6027\u306e vestibular neuritis \u306e\u5834\u5408\u3001\u4e00\u65b9\u5411\u306b\u9650\u5b9a\u3055\u308c\u305f unidirectional<\/strong><\/span> \u306a nystagmus \u304chorizontal<\/strong><\/span> \u306b\u73fe\u308c\u307e\u3059\u3002\u3053\u308c\u306b\u5bfe\u3057\u3066\u4e2d\u67a2\u6027\u306e stroke \u306e\u5834\u5408\u3001\u4e0a\u4e0b\u306b\u65b9\u5411\u304c\u5909\u308f\u308b bidirectional<\/strong><\/span> \u306a nystagmus \u304c vertical<\/strong><\/span> \u306b\u73fe\u308c\u307e\u3059\u3002<\/span><\/p>\r\n

\u6b21\u306b\u78ba\u8a8d\u3059\u308b\u306e\u304c Test of Skew<\/strong><\/span> \u3067\u3059\u3002\u82f1\u8a9e\u306e skew<\/strong> \u306b\u306f\u300c\u6b6a\u307f<\/strong>\u300d\u300c\u6b6a\u3081\u308b<\/strong>\u300d\u300c\u6b6a\u3093\u3067\u3044\u308b<\/strong>\u300d\u306e\u3088\u3046\u306a\u610f\u5473\u304c\u3042\u308a\u3001\u3053\u3053\u3067\u306f\u60a3\u8005\u3055\u3093\u306e\u773c\u304c\u5782\u76f4\u65b9\u5411\u306b\u504f\u4f4d\u3059\u308b\u304b\u3069\u3046\u304b<\/strong>\u3092\u78ba\u8a8d\u3057\u307e\u3059\u3002\u5177\u4f53\u7684\u306b\u306f\u4e0b\u8a18\u306e3\u3064\u306e\u30b9\u30c6\u30c3\u30d7<\/span><\/a>\u3067\u884c\u3044\u307e\u3059\u3002<\/span><\/p>\r\n

1.\u3000<\/em>Ask the patient to look at your nose and subsequently cover one of their eyes.<\/span>
\r\n2.\u3000<\/em>Then, quickly move your hand to cover the patient\u2019s other eye. During this process,
\r\n\u3000\u3000observe the uncovered eye for any vertical and\/or diagonal corrective movement.<\/span>
\r\n3.\u3000<\/em>Repeat this maneuver on the other eye.<\/span><\/p>\r\n

\u3053\u3053\u3067 vertical skew<\/strong><\/span> \u304c\u751f\u3058\u308c\u3070 central vertigo \u3067\u3042\u308b stroke \u3092\u8003\u3048\u307e\u3059\u3002<\/span><\/p>\r\n

\u6700\u5f8c\u306b\u884c\u3046\u306e\u304c Head Impulse<\/span> test<\/strong> \u3067\u3059\u3002\u3053\u3053\u3067\u306f\u4e0b\u8a18\u306e\u3088\u3046\u306a\u30b9\u30c6\u30c3\u30d7<\/span><\/a>\u3067\u60a3\u8005\u3055\u3093\u306e\u9854\uff08\u82f1\u8a9e\u3067\u306f\u3053\u306e\u5834\u5408\u3001face \u3067\u306f\u306a\u304f head \u3068\u8868\u73fe\u3057\u307e\u3059\uff09\u3092\u5de6\u53f3\u306b\u56de\u65cb\u3055\u305b\u307e\u3059\u3002<\/span><\/p>\r\n

1.\u3000<\/em>Gently move the patient\u2019s head side to side, making sure the neck muscles are relaxed.<\/span>
\r\n2.\u3000<\/em>Then ask the patient to keep looking at your nose whilst you turn their head left and right.<\/span>
\r\n3.\u3000<\/em>Turn the patient\u2019s head 10-20\u00b0 to each side rapidly and then back to the midpoint.<\/span><\/p>\r\n

\u3053\u306e head impulse test \u3067\u306f\u3001vestibular neuritis \u304c\u3042\u308b\u5834\u5408\u306b\u7570\u5e38\u6240\u898b\u304c\u73fe\u308c\u307e\u3059<\/strong>\u3002\u6b63\u5e38\u3084 stroke \u306e\u5834\u5408\u3001\u7d20\u65e9\u304f\u9854\u3092\u6b63\u9762\u306b\u56de\u65cb\u3057\u3066\u623b\u3057\u3066\u3082\u773c\u306f\u6b63\u9762\u3092\u5411\u3044\u305f\u307e\u307e\u3067\u3059\u3002\u3057\u304b\u3057\u773c\u304c\u884c\u304d\u904e\u304e\u305f\u5f8c\u306b\u4e2d\u592e\u306b\u623b\u308c\u3070\u3001\u305d\u308c\u3092 corrective saccade<\/strong><\/span> \u3068\u547c\u3073\u3001\u7570\u5e38\u6240\u898b\u3068\u3057\u3066 vestibular neuritis \u3092\u793a\u5506\u3059\u308b\u306e\u3067\u3059\u3002\u3053\u306e saccade<\/strong> \u3068\u306f jerking movements\u300c\u30ac\u30c3\u30af\u30f3\u30ac\u30c3\u30af\u30f3\u3068\u3059\u308b\u3088\u3046\u306a\u52d5\u304d\u300d\u3068\u3044\u3046\u610f\u5473\u3067\u3001\u300c\u30b5\u30c3\u30ab<\/strong>\u30fc\u30c9\u300d\u306e\u3088\u3046\u306b\u767a\u97f3\u3057\u307e\u3059\u3002<\/span><\/p>\r\n

\u305d\u3057\u3066 BPPV \u304b\u3069\u3046\u304b\u3092\u78ba\u8a8d\u3059\u308b\u305f\u3081\u306b\u306f Dix-Hallpike test<\/strong><\/span><\/a><\/span> \u3068\u547c\u3070\u308c\u308b physical exam \u3092\u884c\u3044\u307e\u3059\u3002\uff08\u3053\u306e Dix-Hallpike \u306f\u300c\u30c7\u30a3<\/strong>\u30c3\u30af\u30b9\u30fb\u30db\u30a9\u30a5<\/strong>\u30d1\u30a3\u30af\u300d\u306e\u3088\u3046\u306b\u767a\u97f3\u3057\u307e\u3059\u3002\uff09<\/span><\/p>\r\n

BPPV<\/strong> \u306f\u7c21\u5358\u306b\u8a00\u3046\u3068\u3001 otoliths<\/strong>\u300c\u8033\u77f3<\/strong>\u300d\u304c semicircular canals<\/strong>\u300c\u534a\u898f\u7ba1<\/strong>\u300d\u306b\u8ff7\u5165\u3059\u308b\u3053\u3068\u3067\u3001\u8aa4\u3063\u305f\u5e73\u8861\u611f\u899a\u304c\u8133\u306b\u9001\u3089\u308c\u3066 vertigo \u304c\u751f\u3058\u308b\u3068\u3044\u3046\u75c5\u6c17\u3067\u3059\u3002\u305d\u3057\u3066\u3053\u306e Dix-Hallpike test \u3067\u306f\u3001otoliths \u304c\u8ff7\u5165\u3057\u305f semicircular canal \u3092\u7279\u5b9a\u3059\u308b\u3053\u3068\u3082\u53ef\u80fd\u3068\u306a\u308a\u307e\u3059\u3002\u3053\u306e Dix-Hallpike test \u3067BPPV \u3068\u8a3a\u65ad\u3055\u308c\u3001otoliths \u306e\u8ff7\u5165\u90e8\u4f4d\u304c\u7279\u5b9a\u3067\u304d\u305f\u3089\u3001Epley maneuver<\/strong><\/span><\/a><\/span> \u3068\u547c\u3070\u308c\u308b\u8033\u77f3\u7f6e\u63db\u6cd5\u3067\u6cbb\u7642\u3057\u307e\u3059\u3002<\/span><\/p>\r\n

\u4ee5\u4e0a\u304c ATTEST<\/strong> \u306e\u30a2\u30d7\u30ed\u30fc\u30c1\u6cd5\u306b\u3088\u308b dizziness \u306e\u8a3a\u65ad\u3067\u3059\u3002\u3069\u3046\u3067\u3057\u3087\u3046\uff1f\u5c11\u3057\u306f\u7686\u3055\u3093\u306e\u300c\u3081\u307e\u3044\u300d\u3082\u89e3\u6d88\u3055\u308c\u305f\u3067\u3057\u3087\u3046\u304b\uff1f<\/span><\/p>\r\n

\u3055\u3066\u3001\u305d\u308d\u305d\u308d\u30ab\u30c3\u30d7\u306e\u30b3\u30fc\u30d2\u30fc\u3082\u6b8b\u308a\u308f\u305a\u304b\u3067\u3059\u3002\u6700\u5f8c\u306b dizziness \u306e\u8a3a\u65ad\u306e\u6d41\u308c\u3092\u3082\u3046\u4e00\u5ea6\u7c21\u5358\u306b\u307e\u3068\u3081\u3066\u304a\u304d\u307e\u3059\u3002<\/span><\/p>\r\n

1.\u3000<\/em>\u60a3\u8005\u3055\u3093\u304c dizziness \u3092\u8a34\u3048\u308b\u5834\u5408\u3001\u307e\u305a\u306f Red Flag<\/strong><\/span> \u306e\u6709\u7121\u3092\u78ba\u8a8d\u3059\u308b\u3002<\/span>
\r\n2.\u3000<\/em>\u8a3a\u5bdf\u6642\u306b\u3082 dizziness \u304c\u7d9a\u3044\u3066\u3044\u308b<\/strong>\u5834\u5408\u3001vestibular neuritis<\/strong> \u304b stroke<\/strong> \u304b\u3092 HINTS exam<\/strong> \u3067\u9451\u5225\u3059\u308b\u3002<\/span><\/p>\r\n

HINTS exam<\/strong><\/span><\/a><\/span><\/p>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
\u00a0<\/td>\r\nVestibular Neuritis<\/th>\r\nStroke<\/th>\r\n<\/tr>\r\n<\/thead>\r\n
Nystagmus<\/th>\r\nUnidirectional & Horizontal<\/td>\r\nBidirectional & Vertical<\/td>\r\n<\/tr>\r\n
Test of Skew<\/th>\r\nNo Vertical Skew<\/td>\r\nVertical Skew<\/td>\r\n<\/tr>\r\n
Head Impulse<\/th>\r\nCorrective Saccade<\/td>\r\nNo Corrective Saccade<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

3.\u3000<\/em>\u8a3a\u5bdf\u6642\u306b dizziness \u304c\u306a\u304f\u3066\u30c8\u30ea\u30ac\u30fc\u304c\u3042\u308b<\/strong>\u5834\u5408\u3001BPPV<\/strong> \u304b\u3069\u3046\u304b\u3092 Dix-Hallpike test<\/strong><\/span><\/a> \u3067\u78ba\u8a8d\u3059\u308b\u3002
\r\n\u3000\u3000\u306a\u3051\u308c\u3070 orthostatic hypotension<\/strong> \u3092\u7591\u3046\u3002<\/span>
\r\n4.\u3000<\/em>\u8a3a\u5bdf\u6642\u306b dizziness \u304c\u306a\u304f\u3066\u30c8\u30ea\u30ac\u30fc\u304c\u306a\u3044<\/strong>\u5834\u5408\u3001vestibular migraine<\/strong> \u3084 Meni\u00e8re’s disease<\/strong> \u306a\u3069\u3092\u8003\u3048\u308b\u3002
\r\n\u3000\u3000TIA<\/strong>\u3082\u5fd8\u308c\u306a\u3044<\/span><\/p>\r\n

\u3067\u306f\u3001\u307e\u305f\u306e\u3054\u6765\u5e97\u3092\u304a\u5f85\u3061\u3057\u3066\u304a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n

\u5f15\u7528\u6587\u732e<\/strong><\/span>
\r\nEdlow JA, Gurley KL, Newman-Toker DE. A new diagnostic approach to the adult patient with acute dizziness. The Journal of emergency medicine. 2018 Apr 1;54(4):469-83.<\/span><\/p>\r\n

\u300cDr. \u62bc\u5473\u306e\u533b\u5b66\u82f1\u8a9e\u30ab\u30d5\u30a7\u300d\u3067\u306f\u7686\u3055\u3093\u304b\u3089\u6271\u3063\u3066\u6b32\u3057\u3044\u30c8\u30d4\u30c3\u30af\u3092\u52df\u96c6\u3044\u305f\u3057\u307e\u3059\u3002\u3053\u3061\u3089\u306e\u30ea\u30f3\u30af<\/strong><\/span><\/a>\u304b\u3089\u3053\u306e\u30ab\u30d5\u30a7\u3067\u6271\u3063\u3066\u6b32\u3057\u3044\u3068\u601d\u3046\u533b\u5b66\u82f1\u8a9e\u306e\u30c8\u30d4\u30c3\u30af\u3092\u3054\u81ea\u7531\u306b\u8a18\u8f09\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n

\u56fd\u969b\u533b\u7642\u798f\u7949\u5927\u5b66\u533b\u5b66\u90e8 \u533b\u5b66\u6559\u80b2\u7d71\u62ec\u30bb\u30f3\u30bf\u30fc \u6559\u6388\u3000\u62bc\u5473 \u8cb4\u4e4b<\/p>\r\n\r\n\r\n","protected":false},"excerpt":{"rendered":"\u3053\u3093\u306b\u3061\u306f\u3002\u300c\u533b\u5b66\u82f1\u8a9e\u30ab\u30d5\u30a7\u300d\u306b\u3088\u3046\u3053\u305d\uff01 \u3053\u3053\u306f\u300c\u30b3\u30fc\u30d2\u30fc1\u676f\u5206\u300d\u306e\u6642\u9593\u3067\u3001\u533b\u5b66\u82f1\u8a9e\u306b\u307e\u3064\u308f\u308b\u8a71\u3092\u6c17\u8efd\u306b\u697d\u3057\u3093\u3067\u3044\u305f\u3060\u304f\u30b3\u30fc\u30ca\u30fc\u3067\u3059\u3002 \u672c\u65e5\u306e\u30c6\u30fc\u30de\u306f\u300c\u3081\u307e\u3044\u306b\u95a2\u3059\u308b\u82f1\u8a9e\u8868\u73fe\u300d\u3002 \u300c\u3081\u307e\u3044\u300d\u306e\u8a3a\u5bdf\u3068\u805e\u3044\u3066\u3001\u300c\u305d\u308c\u3001\u5f97\u610f","protected":false},"author":1,"featured_media":6881,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"onecolumn-960.php","format":"standard","meta":{"_acf_changed":false,"_jin_ogp_image_url":"","_jin_last_featured_id":0,"footnotes":""},"categories":[63],"tags":[],"class_list":["post-6957","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-eigocafe"],"acf":[],"_links":{"self":[{"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/posts\/6957","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/comments?post=6957"}],"version-history":[{"count":1,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/posts\/6957\/revisions"}],"predecessor-version":[{"id":6958,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/posts\/6957\/revisions\/6958"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/media\/6881"}],"wp:attachment":[{"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/media?parent=6957"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/categories?post=6957"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wp.meccari.jp\/api\/wp\/v2\/tags?post=6957"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}