頸部椎間盤突出所致之頸源性頭暈

Cervical Intervertebral Disc Herniation with Cervicogenic Dizziness

頸源性頭暈定義為「源自於頸部不正常的感覺傳入，造成一種空間改變或是身體不平穩的非特異性感覺」。一54歲女性，因反覆發作低頭頭暈半年而求診，理學檢查顯示在頸部屈曲時，確實會引起主觀性的失衡感與頸部肌肉的麻痛，但無Lhermitte氏或Brudzinski氏徵候，前庭功能檢查、聽力檢查、心電圖、電氣眼振圖、頸性前庭誘發肌性電位、血液學檢查、頸椎X光與頸部動脈超音波檢查均無異常發現。合併血管造影之腦部磁振造影無異常發現，但矢狀面發現有第3-6節頸部椎間盤突出。診斷為頸部椎間盤突出所致之頸源性頭暈。建議配帶硬式頸圈，往後1週，症狀不再發作。往後6個月，患者持續配帶硬式頸圈，情況依然穩定。由於頸部涉及平衡控制（頸部傳入）、血管張力調控（頸動脈竇）、血液循環（頸動脈和椎動脈）、支持與保護脊髓（頸椎），任一處病變均有可能促成頸源性頭暈，目前並無特定的檢查可以直接確診，在診治時應當先設法排除重大疾患，並找尋潛在病因。

Cervicogenic dizziness is defined as "a non-specific sensation of altered orientation in space and disequilibrium originating from abnormal afferent activity from neck". A 54-yearold woman presented with frequent episodic dizziness related to head flexion in the last six months. Physical examination showed subjective imbalance and nuchal pain and numbness with neck flexion; there was, however, no Lhermittes sign or Brudzinskis sign. Results of vestibular function test, pure tone audiometry, electrocardiogram, electronystagmogram, cervical vestibularevoked myogenic potential, blood tests, cervical spinal X-ray, and neck duplex ultrasonography all appeared non-contributory. While similarly unremarkable, brain magnetic resonance imaging/angiogram did demonstrate herniation of C3-6 intervertebral discs. Wearing a rigid neck collar to immobilize the neck resulted in the disappearance of the symptom in the following week, and the patient, continuing to use the prescribed neck collar, no longer experience the dizziness symptom during the next six-month follow-up period. Various neck structures are involved in balance control (cervical afferents of musculatures), vascular tone control (carotid sinuses), blood circulation (carotid and vertebral arteries), and support and protection of the spinal cord (cervical vertebra); anomaly in any of these neck structures would contribute to cervicogenic dizziness. So far, there has been no specific test capable of expediting the diagnosis of cervicogenic dizziness; physicians should accordingly make it a priority to exclude any major pathologic lesions of the neck that may contribute to the symptom of dizziness.