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Gepubliceerd in:
2016 | OriginalPaper | Hoofdstuk
1. Duizeligheid
Auteurs : O. R. Maarsingh, H. de Vries, R. A. M. de Jonckheere, J. K. Plantenga
Gepubliceerd in: Diagnostiek van alledaagse klachten
Uitgeverij: Bohn Stafleu van Loghum
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Samenvatting
Duizeligheid is voor arts en patiënt een vage klacht. Voor de patiënt is ongerustheid regelmatig aanleiding voor een bezoek aan de arts. Vooral de anamnese is behulpzaam bij het stellen van een diagnose. Zeer zelden is sprake van een ernstige aandoening die verwijzing nodig maakt. Duizeligheid op het spreekuur bij de huisarts is op voorhand niet een typisch KNO-probleem; met name bij ouderen is regelmatig sprake van een cardiovasculaire oorzaak of multifactorieel bepaalde bewegingsonzekerheid. Uitgangspunt bij de diagnostiek zijn de karakteristieken van de duizeligheid, zoals aard, beloop en uitlokkende factoren. Is er sprake van draaiduizeligheid, dan is het evenwichtsorgaan meestal de bron van de klacht. Acute, heftige en langer durende draaiduizeligheid kan wijzen op de ziekte van Ménière, neuritis vestibularis of – zelden – een CVA. Bij herhaalde, korte aanvallen gaat het dikwijls om benigne paroxismale positieveranderingsduizeligheid. Vaak vormt het uitlokkend moment de sleutel voor de diagnose: provocatie van klachten door opstaan (orthostatische hypotensie), bij opstaan en gaan lopen (desequilibrium), bij schrik of pijn (vasovagale collaps) of bij inspanning (cardiovasculaire aandoening). Een licht gevoel in het hoofd kan ook continu aanwezig zijn (angststoornis, medicatiegebruik). Bij draaiduizeligheid wordt vaak de kiepproef van Dix-Hallpike aanbevolen. Een nuttige aanvulling hierop zou de Head Impulse Test kunnen zijn. Indien geen duidelijke diagnose kan worden gesteld, is het zinvol factoren te identificeren die bijdragen aan de duizeligheid (en ook daadwerkelijk te behandelen zijn). Voorbeelden hiervan zijn medicatiegebruik, visus, gehoor, mobiliteit en psychische status (angst, depressie). Alarmsignalen zijn langdurige duizeligheid met eenzijdig gehoorverlies, acute doofheid, nieuwe hoofdpijn en neurologische symptomen zoals diplopie, dysartrie, ataxie of parese (aandoeningen cerebellum of hersenstam).
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Metagegevens
- Titel
- Duizeligheid
- Auteurs
-
O. R. Maarsingh
H. de Vries
R. A. M. de Jonckheere
J. K. Plantenga
- Copyright
- 2016
- Uitgeverij
- Bohn Stafleu van Loghum
- Boek
-
Diagnostiek van alledaagse klachten
Print ISBN: 978-90-368-1154-5
Elektronisch ISBN: 978-90-368-1274-0
Copyright: 2016
- DOI
- https://doi.org/10.1007/978-90-368-1274-0_1