Vertigoya Acil Yaklaşım
Özet
Toplumda yaygın görülen ve nörolojik aciller arasında ilk sıralarda yer alan vertigo, hastanın kendisinin veya çevresinin hareket ettiğini hissettiği bir illüzyondur. Doğru tanı için öncelikle vital bulgular kontrol edilmeli, ardından detaylı anamnez ve fizik muayene ile vertigonun santral veya periferik kökenli olup olmadığı belirlenmelidir. İç kulak veya vestibüler sinir kaynaklı periferik vertigo ani başlangıçlı ve şiddetliyken; beyin sapı veya serebellum kaynaklı santral vertigo yavaş başlangıçlıdır ve nörolojik belirtiler eşlik edebilir. Tanıda semptomların süresi (saniyeler, saatler veya günler) kritik bir rol oynar; örneğin BPPV saniyeler, Meniere hastalığı saatler sürer. Fizik muayenede kardiyovasküler sistem, otoskopik bulgular ve göz hareketleri (nistagmus) detaylıca incelenir, şüpheli santral vakalarda ise BT ve MRG gibi ileri görüntüleme testlerine başvurulur. Tedavinin temel amacı nedene yönelik olmalıdır; periferik vertigoda kısa süreli vestibüler supresanlar, antiemetikler ve Cawthorne-Cooksey egzersizleri tercih edilir. Tüm vertigoların üçte birini oluşturan BPPV’de medikal tedavinin rutinde yeri yoktur, tanı Dix-Hallpike testiyle konulup Epley manevrası gibi repozisyon egzersizleriyle başarıyla tedavi edilir. Meniere hastalığında ise dalgalı işitme kaybı ve çınlama görülür, tedavisinde İV/oral supresanlar kullanılır.
Vertigo, which is highly prevalent in the community and ranks among the top neurological emergencies, is an illusion where patients feel that they or their surroundings are moving. For an accurate diagnosis, vital signs must be checked first, followed by a detailed history and physical examination to determine whether the vertigo is of central or peripheral origin. Peripheral vertigo, originating from the inner ear or vestibular nerve, is sudden and severe, whereas central vertigo, arising from the brainstem or cerebellum, has a slow onset and may be accompanied by neurological symptoms. The duration of symptoms (seconds, hours, or days) plays a critical role in diagnosis; for instance, BPPV lasts for seconds, while Meniere's disease persists for hours. The physical examination thoroughly evaluates the cardiovascular system, otoscopic findings, and eye movements (nystagmus), and advanced imaging tests like CT and MRI are utilized in suspected central cases. The primary goal of treatment must be etiology-specific; short-term vestibular suppressants, antiemetics, and Cawthorne-Cooksey exercises are preferred in peripheral vertigo. In BPPV, which constitutes one-third of all vertigo cases, medical treatment has no routine place; it is diagnosed via the Dix-Hallpike test and successfully treated with repositioning maneuvers like the Epley maneuver, whereas Meniere's disease presents with fluctuating hearing loss and tinnitus, managed with IV or oral suppressants.
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