2014년 건강보험심사평가원 환자표본데이터 분석을 이용한 현훈환자의 의료비용에 관한 연구

김봉주 ( Bong Joo Kim ),강형원 ( Hyung Won Kang ),김남권 ( Nam-kwen Kim ),서은성 ( Eun-sung Seo ) 대한한방신경정신과학회 2018 동의신경정신과학회지 Vol.29 No.3

Objectives: The purpose of this study was to analyze the medical cost for patients with vertigo and to examine associations between chronic vertigo and mental disorder using 2014 Health Insurance Review & Assessment Service-National Patients Sample (HIRA-NPS). Methods: We analyzed sociodemographic characteristics, medical cost and medical care use pattern for vertigo patients. We used hierarchical multiple logistic regression analysis to examine odds ratio between chronic vertigo and mental disorder. Results: A total of 46,502 people and 118,504 claims data were identified for vertigo cases. Characteristics of vertigo patients have significant differences on proportion of female patients (68.36%), patients’ average age (54.98) and proportion of medical assistance (5.76%) compared with non-vertigo patients. Results revealed that Korean medicine are one of frequent methods among total treatments for vertigo patients. Total days of medical care and total costs are 2.78 days and 111,362 won, respectively, and days for outpatients in Korean medical care (mean: 2.26 days) are more than those (mean: 5.05 days) in Western medical care. There is significant difference relative to sex between acute vertigo and chronic vertigo. The odds ratio between chronic vertigo and mental disorder is estimated as 1.34, that means risk of becoming chronic is 34% higher for vertigo patients with mental disorder. Conclusions: This study assessed socio-demographic characteristics, medical care use and expenses related to vertigo, and estimated associations between chronic vertigo and mental disorder. Findings provide a basis for economic evaluation studies on vertigo patients and development of clinical practice guidelines for vertigo patients with mental disorder.

어지럼 환자의 병력청취

반재호,김민범 대한평형의학회 2012 Research in Vestibular Science Vol.11 No.-

Vertigo can be defined as an illusion or hallucination of movement. Vertigo can be caused by many different pathologies, some of which are potentially life threatening. The differential diagnosis of vertigo includes peripheral vestibular causes (i.e., those originating in the peripheral nervous system), central vestibular causes (i.e., those originating in the central nervous system), and other conditions. Benign paroxysmal positional vertigo, acute vestibular neuritis, and Ménière’s disease cause most cases of vertigo; however, the physicians who see the vertigo patients must consider other various causes including cerebrovascular disease, migraine, psychological disease, perilymphatic fistulas, multiple sclerosis, and intracranial neoplasms. History is the most important part of the assessment. Key questions should be asked and it is vital to establish if the patient is suffering from vertigo or some other complaint such as anxiety or syncope. History alone reveals the diagnosis in roughly three out of four patients complaining of dizziness, although the proportion in patients specifically complaining of vertigo is unknown. When collecting a patient’s history, the physician first must determine whether the patient truly has vertigo versus another type of dizziness. Once it is determined that a patient has vertigo, the next task is to determine whether the patient has a peripheral or central cause of vertigo. Key information from the history includes the timing and duration of the vertigo, what provokes or aggravates it, and whether any associated symptoms exist, especially neurologic symptoms and hearing loss. Other important clues to the diagnosis of vertigo may come from the patient’s medical history, including medications, trauma, or exposure to toxins. A neurological and otological examination should be performed, appropriate to the history. Associated neurologic signs and symptoms, such as nystagmus that does not lessen when the patient focuses, point to central (and often more serious) causes of vertigo, which require further work-up with selected laboratory and radiologic studies such as magnetic resonance imaging. Because patients with dizziness often have difficulty describing their symptoms, determining the cause can be challenging. An evidence-based approach using knowledge of key historic, physical examination, and radiologic findings for the causes of vertigo can help physicians establish a diagnosis and consider appropriate treatments in vertigo patients.

뇌졸중(腦卒中) 전조증상(前兆症狀)으로서의 현훈(眩暈)에 대한 설문조사분석(設問調査分析)

고성규,용형순,Ko, Sung-Gyu,Yong, Hyung-Soon 대한한방내과학회 2000 大韓韓方內科學會誌 Vol.21 No.1

Objective : This study has been made to analysis of clinical type of vertigo prodromic Cerebral Vascular Disease in stroke patients who admitted to sangji oriental hospital department of circulatoty internal medicine in the period from July. 1999 to October 1999. Methods : A Questionaire was done after explanationin details to patients and agreement of patients. The inquire was done as follows. Sex and age, risk factor of stroke, type of stroke, existence of vertigo last three years before stroke attack, the beginning age of vertigo and period of prevalence, frequency, continuance time of vertigo, predilection season and time, factor of causing vertigo, accompanying symptoms of vertigo, severity of vertigo. Result and Conclusion : The existence of Rotation sense(Rotation group and non-Rotation group) and the type of Stroke is no difference significantly but the Rotation vertigo group and non-Rotation vertigo group is difference significantly in distribution. The sixties in age of vertigo attack, previous vertigo before 3 year Stroke attack, irregular in predilection season of vertigo, have a high frequency significantly in distribution and previous period of vertigo has no significantly difference in distribution. One or two per a month in frequency of vertigo, below 5 minute in continuance time of vertigo, irregular in predilection time of vertigo, stand up and sit down in causing vertigo position have a high frequency significantly in distribution.

말초성 현기증의 감별진단

배창훈 영남대학교 의과대학 2014 Yeungnam University Journal of Medicine Vol.31 No.1

Dizziness can be classified mainly into 4 types: vertigo, disequilibrium, presyncope, and lightheadedness. Among these types, vertigo is a sensation of movement or motion due to various causes. The main causes of peripheral vertigo are benign paroxysmal positional vertigo (BPPV), acute vestibular neuritis (AVN), and Meniere’s disease. BPPV is one of the most common causes of peripheral vertigo. It is characterized by brief episodes of mild to intense vertigo, which are triggered by specific changes in the position of the head. BPPV is diagnosed from the characteristic symptoms and by observing the nystagmus such as in the Dix-Hallpike test. BPPV is treated with several canalith repositioning procedures. AVN is the second most common cause of peripheral vertigo. Its key symptom is the acute onset of sustained rotatory vertigo without hearing loss. It is treated with symptomatic therapy with antihistamines, anticholinergic agents, antidopaminergic agents, and gamma-aminobutyric acid-enhancing agents that are used for symptoms of acute vertigo. Meniere’s disease is characterized by episodic vertigo, fluctuating hearing loss, and tinnitus. It is traditionally relieved with life-style modification, a low-salt diet, and prescription of diuretics. However, diagnosis and treatment of the peripheral vertigo can be difficult without knowledge of BPPV, AVN, and Meniere’s disease. This article provides information on the differential diagnosis of peripheral vertigo in BPPV, AVN, and Meniere’s disease.

양성재발성현훈의 임상양상 및 전정기능검사 소견

김창효,최호석,정윤건,이승철,김규성 대한평형의학회 2008 Research in Vestibular Science Vol.7 No.1

Background and Objectives: Benign recurrent vertigo has been defined as recurrent spells of vertigo lasting minutes to hours without cochlear and neurologic signs. The etiology is still unclear, but viral and vasospastic etiology as migraine equivalent has been suggested. We attempt to analyze the symptoms and vestibular function test of Benign recurrent vertigo that has clinically diagnosed. Materials and Methods: We analyzed retrospectively the clinical characteristics and vestibular function test including ocular-motor test, rotation test and computerized dynamic posturography from 100 patients with a Benign recurrent vertigo diagnosis. Results: Eight two percent of the patients were female, mean age was 52 years, and mean duration of prevalence was 47.3 months. In the characteristics of vertigo, 91% of patients have spinning sensation during attack. The vertigo attacks most commonly lasts several hours (57%), and frequency of attack is three to twelve time per year in 47%. A high incidence (40%) of headache was detected, but incidence of other associated symptoms including fluctuating hearing loss (3%), tinnitus (27%), aural fullness (9%) was relatively low. The incidence of spontaneous nystagmus and positional nystagmus was 18% and 10% each. Saccadic undershoot was observed in 21% of patients, but it was not associated with other ocular-motor test abnormalities. In rotation test, low gain, phase lead and asymmetry was observed in 18%, 3% and 9%, respectively. There were no abnormal findings in posturography. Conclusions: Although benign recurrent vertigo did not show any characteristic clinical findings or vestibular function test, it deserves to be considered for differential diagnosis of episodic vertigo. Background and Objectives: Benign recurrent vertigo has been defined as recurrent spells of vertigo lasting minutes to hours without cochlear and neurologic signs. The etiology is still unclear, but viral and vasospastic etiology as migraine equivalent has been suggested. We attempt to analyze the symptoms and vestibular function test of Benign recurrent vertigo that has clinically diagnosed. Materials and Methods: We analyzed retrospectively the clinical characteristics and vestibular function test including ocular-motor test, rotation test and computerized dynamic posturography from 100 patients with a Benign recurrent vertigo diagnosis. Results: Eight two percent of the patients were female, mean age was 52 years, and mean duration of prevalence was 47.3 months. In the characteristics of vertigo, 91% of patients have spinning sensation during attack. The vertigo attacks most commonly lasts several hours (57%), and frequency of attack is three to twelve time per year in 47%. A high incidence (40%) of headache was detected, but incidence of other associated symptoms including fluctuating hearing loss (3%), tinnitus (27%), aural fullness (9%) was relatively low. The incidence of spontaneous nystagmus and positional nystagmus was 18% and 10% each. Saccadic undershoot was observed in 21% of patients, but it was not associated with other ocular-motor test abnormalities. In rotation test, low gain, phase lead and asymmetry was observed in 18%, 3% and 9%, respectively. There were no abnormal findings in posturography. Conclusions: Although benign recurrent vertigo did not show any characteristic clinical findings or vestibular function test, it deserves to be considered for differential diagnosis of episodic vertigo.

The clinical significance of arterial stiffness in the differential diagnosis of vertigo

Cho Bang-Hoon,Kim Jae-Myung,김영인,이승한 대한평형의학회 2024 Research in Vestibular Science Vol.23 No.1

Objectives: Pulse wave velocity (PWV) is a known indicator of arterial stiffness reflecting vascular damage. However, there are few reports of the relationship between PWV and dizziness/vertigo of a vascular origin. We investigated whether the PWV value could be useful as an ancillary measurement for identifying the etiology of dizziness/vertigo.Methods: We enrolled dizzy patients from March 2016 to December 2018. The patients with posterior circulation stroke presenting with dizziness/vertigo were categorized as having central vertigo. The patients with vertigo due to benign paroxysmal positional vertigo, Ménière disease, or acute unilateral vestibulopathy were categorized as having peripheral vertigo. The PWV value, ankle-brachial index (ABI), and traditional vascular risk factors were collected.Results: We consecutively enrolled a total of 93 participants. The PWV values were higher in the central vertigo group (p<0.001), but ABI did not differ between the groups. Among the vascular risk factors, the number of patients with diabetes mellitus, dyslipidemia, and male patients was significantly higher in the central vertigo group. The brachial-ankle PWV (baPWV) values were higher in the central vertigo group, even after adjusting for confounding factors (p<0.01). The receiver operating characteristic curve showed that the sensitivity was 74% and specificity was 81% when the mean baPWV value was 14.78 m/sec.Conclusions: Increased baPWV values were observed in patients with dizziness/vertigo due to stroke. Measurement of the baPWV value could be an ancillary test for evaluating the cause of dizziness/vertigo, even though more convincing evidence is still required.

소아청소년 두통에서 어지럼과 기립불내성

김 승 효 대한의사협회 2017 대한의사협회지 Vol.60 No.2

Pediatric migraine is followed by more frequent episodes of dizziness or vertigo than tension-type headaches. Just as children with migraine show a high sensitivity to light and noise, they are also susceptible to vestibular stimuli, resulting in vertigo or dizziness. Previous studies have found vertigo to be more common among patients with migraine. Vestibular migraine and benign paroxysmal vertigo of childhood have been identified as the most common causes of vertigo in children without ear disease. Benign paroxysmal vertigo of childhood is also thought to be a precursor of later episodes of migraine. The term vestibular migraine was included as a part of the appendix in the International Classification of Headache Disorders 3rd edition beta version, as an increasing number of studies have shown a positive relationship between migraine and vertigo. However, vertigo cannot be easily identified by parents or pediatricians, as young children are unable to explain their vertigo- or migraine-related symptoms. This is also applicable to specialists such as pediatric neurologists and otolaryngologists, as they often do not know the exact definition of vertigo in such patients and cannot make the correct differential diagnosis. Consequently, the inadequate evaluation and treatment of these patients can lead to a high socioeconomic cost. This review article discussing vertigo in pediatric migraine will help more medical doctors to effectively examine, accurately diagnose, and promptly treat young children suffering from migraine or vertigo.

응급실에 내원한 환자에서 어지럼증의 원인과 임상양상의 분석

문원식,정경운,위준선,문정미,전병조,김용권,소정일,류진호,허탁,민용일 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: Recently, The number of patients who have been complaining of the vertigo or dizziness has been increasing due to rapid growth of elderly population and senile disease. The differentiation of dizzy patients is not familiar to most emergency physicians. This study was designed to differentiate true vertigo and to investigate the clinical difference among central vertigo, peripheral vertigo, and other causes of dizziness. Methods: The authors analyzed the cases of 237 dizzy patients who visited the emergency department of Chonnam University Hospital during the recent 2 years. For the base of dizziness, associated past illnesses, severity, nystagmus type, and the causes of central and peripheral vertigo. Results: Female patients were 142(59.9%) and male patients were 95(40.1%). The most common age group was the 6th decade. The origin of dizziness was classified as peripheral cause(25.3%), central cause(32.9%), and others(41.8%). As to nature of the dizziness, the rotatory sense was dominant in peripheral vertigo and the floating sense and blurred vision in central vertigo. Peripheral vertigo was triggered by position change of head and body, and central vertigo by the eye movement. Audiograms I showed that most patients with central vertigo had normal hearing, but 46.7% of thoswith peripheral vertigo had an abnormal hearing disturbance. Nystagmus was more prevalent in peripheral vertigo Conclusion: History taking and physical examination played an important role in the diagnosis of dizzy patients. An important part of the diagnosis of a dizzy patient could be to evaluate the peripheral origin, the central origin and others causes. Because central vertigo may be associated with a significant neurological pathology, spectral radiological studies, including MRI and CT, are mandatory to rule out a devastating brain lesion.

한방병원에 입원한 두위 현훈 환자의 임상 분석

김태연,김기태,고흥,Kim, Tae-Yeon,Kim, Gi-Tae,Go, Heung 대한한방내과학회 2011 大韓韓方內科學會誌 Vol.32 No.3

Background : Vertigo is a very common complaint in clinical practice. The number of patients who complain of vertigo has been increasing due to rapid growth of the elderly population. This study was designed to review the clinical features and success of oriental medical treatment of positional vertigo. Methods : This observation was made on 70 subjects diagnosed with positional vertigo. They were hospitalized in the Semyung University Oriental Medicine Hospital. Results : The results were as follows 1. Female patients (82.9%) were more than male patients. The most common age group was 8th decade and the patients rapidly increased after the 5th decade of age. 2. The most common past history of positional vertigo was hypertension, the second was cerebral infarction, and the third was hyperlipidemia. 3. In the oriental medicine diagnosis, phlegm-dampness syndrome (痰濕交阻 眩暈) was the most common disease (92.9%), and in western medicine, BPPV was the most (82.9%). 4. In herbal medication, Banhabaekchulchunma-tang gami (45.7%) was the most commonly used, the second being Taeksa-tang (30%). 5. The vertigo score of 94.3% patients improved and none got worse. 6. In general characteristics, men over 64 years improved best. Past history had no effect on the improvement of vertigo. 7. The sooner patients visited hospital after onset, the shorter hospitalization time was. Conclusions : Vertigo attacks patients well in advanced age, with various causative diseases. Oriental medical treatments have considerable effects on positional vertigo, especially treated with Banhabaekchulchunma-tang gami and Taeksa-tang.

안진검사에서 단속운동검사, 시추적검사, 시운동성 안진검사의 임상적 의의

최윤석 ( Yoon Seok Choi ),나형균 ( Hyung Gyun Na ),송시연 ( Si-youn Song ),김용대 ( Yong-dae Kim ),배창훈 ( Chang Hoon Bae ) 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.1

Background: Saccade test, smooth pursuit test, and optokinetic nystagmus test are clinically useful tests to accurately diagnose vertigo. However, there have only been a few studies regarding a correlation between the anatomical site of the lesion and the abnormality of eyeball movement in patients with vertigo. Methods: The medical records of 97 patients with vertigo between January 2006 and June 2008 were re-viewed retrospectively. We classified many kinds of abnormalities regarding the saccade test, smooth pursuit test and optokinetic nystagmus test into several categories and analyzed the localizing lesion of vertigo. Results: According to the saccade test, both total saccade abnormality (S-total) and slow velocity of saccade (S-type 3) were shown to be significantly higher in the central lesion of vertigo. According to the smooth pursuit test, symmetrical unidirectional smooth pursuit abnormality (SP-type 2) was observed to be signifi-cantly higher in the peripheral lesion over vertigo. Moreover, according to the optokinetic nystagmus test, total optokinetic nystagmus abnormalities (OKN-total) were shown to be significantly useful findings in the diagnosis of the central lesion of vertigo. The coexisting abnormalities of all three tests (S+SP+OKN abnor-malities) were shown to be significantly higher in the central lesion of vertigo. Conclusion: These results suggest that all these tests, saccade test, smooth pursuit test, and optokinetic nystagmus test, are very useful to distinguish between the central lesion and the peripheral lesion of vertigo. However, these tests are not beneficial in localizing the central lesion of vertigo.