r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2021-26-4-50-59r-n-j-200Research ArticleЛЕКЦИЯLECTUREВестибулярное головокружение в неотложной неврологииVestibular vertigo in emergency neurologyhttps://orcid.org/0000-0001-6061-8118КулешА. А.KuleshA. A.

Кулеш Алексей Александрович

Пермь

Alexey A. Kulesh

Perm

aleksey.kulesh@gmail.comhttps://orcid.org/0000-0003-2670-4172ДеминД. А.DyominD. A.

Астрахань

Astrakhan

https://orcid.org/0000-0002-7988-4229ГусеваА. Л.GusevaA. L.

Москва

Moscow

https://orcid.org/0000-0002-3847-9366ВиноградовО. И.VinogradovO. I.

Москва

Moscow

https://orcid.org/0000-0002-1992-7960ПарфеновВ. А.ParfyonovV. A.

Москва

Moscow

ФГБОУ ВО «Пермский государственный медицинский университет имени академика Е.А. Вагнера» Минздрава РоссииРоссияFSBEI HE “Perm State Medical University named after the Academician Vagner E.A.”Russian FederationФГБУ «Федеральный центр сердечно-сосудистой хирургии» Минздрава РоссииРоссияFSBI “Federal Cardiovascular Surgery Center” of the Ministry of Healthcare of RussiaRussian FederationФГБУ «Национальный медико-хирургический центр им. Н.И. Пирогова» Минздрава РоссииРоссияFSBI “Pirogov National Medical and Surgical Center” of the Ministry of Healthcare of RussiaRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава РоссииРоссияFSBEI HE “Russian National Research Medical University named after Pirogov N.I.” of the Ministry of Healthcare of RussiaRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова Минздрава России (Сеченовский Университет)»РоссияFSBEI HE “First Moscow State Medical University named after Sechenov I.M. (Sechenov University)” of the Ministry of Healthcare of RussiaRussian Federation2021120820212645059Copyright © Кулеш А.А., Демин Д.А., Гусева А.Л., Виноградов О.И., Парфенов В.А., 20212021Кулеш А.А., Демин Д.А., Гусева А.Л., Виноградов О.И., Парфенов В.А.Kulesh A.A., Dyomin D.A., Guseva A.L., Vinogradov O.I., Parfyonov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/200

В лекции рассматриваются подходы к дифференциальной диагностике причин головокружения в неотложной неврологии. Рассмотрены основные причины эпизодического и острого вестибулярного синдрома. Обсуждены клинические методы диагностики при остром вестибулярном синдроме — оценка нистагма, косой девиации, импульсного теста поворота головы и неврологического статуса. Изложены клинические признаки «доброкачественного» острого вестибулярного синдрома и симптомы, указывающие на инсульт в вертебробазилярной системе. Приведены дифференциально диагностические критерии периферического и центрального вестибулярного расстройства. Рассмотрены изолированное сосудистое головокружение, особенности отоневрологического статуса при вестибулярном нейроните и различной локализации очага инфаркта головного мозга. Обсуждаются ошибки в диагностике причин головокружения.

The review deals with approaches to the differential diagnosis of the causes of vertigo in emergency neurology. The main causes of episodic and acute vestibular syndrome are discussed. Clinical diagnostic methods for acute vestibular syndrome (evaluation of nystagmus, test of skew, head-impulse test and neurological status) are considered. Clinical signs of “benign” acute vestibular syndrome and symptoms indicating a stroke in the vertebrobasilar system are presented. Differential diagnostic criteria for peripheral and central vestibular disorders are presented. Transient ischemic attacks, features of the otoneurologic status in vestibular neuronitis and different localizations of cerebral infarction focus are considered. Errors in the diagnosis of the vertigo causes are discussed.

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The authors declare that there are no conflicts of interest present.