患者感到头晕时会怎么做：行为特征揭示常见前庭疾病的诊断线索。

文献信息

中文摘要

背景： 前庭疾病的诊断在很大程度上依赖临床病史，然而患者如何调整其行为以应对头晕仍相对未被充分探索。我们研究了所采取的回避行为和应对策略是否提供额外的诊断信息以及对疾病机制的见解。
方法： 连续就诊于专科头晕门诊的患者在临床评估前接受了结构化访谈。参与者报告了头晕诱因、回避行为和应对反应。最终诊断由前庭神经科医生独立确定，并使用逻辑回归检验行为模式与诊断之间的关联。
结果： 共纳入109例患者（平均年龄55.3岁；71.5%为女性），包括33例前庭性偏头痛（VM）、33例持续性姿势-知觉性头晕（PPPD）、14例良性阵发性位置性眩晕（BPPV）和15例直立性头晕（OD）。乘车时阅读可预测VM（OR 20.99），视觉刺激环境可预测PPPD（OR 12.45），头部运动可预测BPPV（OR 11.51），而快速站起与OD相关。回避和应对行为同样具有诊断特异性，包括VM中回避明亮或嘈杂环境以及在黑暗或安静环境中休息，PPPD中回避视觉复杂环境并保持活动，BPPV中回避头部运动并在发作期间保持静止；OD患者回避突然站起。
结论： 常见头晕病因的患者表现出反映其疾病潜在机制的不同行为特征。这些直观的适应行为可能提供超越传统症状描述的有价值临床线索。关于回避行为和应对策略的询问可能提高前庭疾病的诊断准确性和理解。

英文摘要

BACKGROUND: Diagnosis of vestibular disorders relies heavily on clinical history, yet how patients adapt their behaviour in response to dizziness remains relatively unexplored. We investigated whether adopted avoidance behaviours and coping strategies provide additional diagnostic information and insights into disease mechanisms.
METHODS: Consecutive patients attending a specialist dizziness clinic underwent a structured interview before clinical assessment. Participants reported dizziness triggers, avoidance behaviours, and coping responses. Final diagnoses were established independently by a vestibular neurologist, and associations between behavioural patterns and diagnosis were examined using logistic regression.
RESULTS: One hundred and nine patients were included (mean age 55.3 years; 71.5% female), including thirty-three with vestibular migraine (VM), thirty-three with persistent postural-perceptual dizziness (PPPD), fourteen with benign paroxysmal positional vertigo (BPPV), and fifteen with orthostatic dizziness (OD). Reading whilst travelling predicted VM (OR 20.99), visually stimulating environments predicted PPPD (OR 12.45), head movements predicted BPPV (OR 11.51) and standing quickly was associated with OD. Avoidance and coping behaviours were similarly diagnosis-specific, including avoidance of bright or noisy environments and resting in dark or quiet settings in VM, avoidance of visually complex environments and maintaining activity in PPPD, and avoidance of head movements and remaining still during attacks in BPPV; OD patients avoided sudden standing.
CONCLUSION: Patients with common causes of dizziness exhibit distinct behavioural signatures that reflect the underlying mechanisms of their disorders. These intuitive adaptations may provide valuable clinical clues beyond conventional symptom descriptions. Questions about avoidance behaviours and coping strategies may improve diagnostic accuracy and understanding of vestibular disorders.