めまいの臨床と対応 : とくに心因の関与するめまいに関して

1) We devised a new equilibrium test termed "Equilibrium test for neurotic vertigo". In this test, a subject who shows development or increase in vertigo and ataxia after an injection of adrenaline is stimulated by hearing suggestive words, such as [I am going to give you an injection of adrenaline], after which physiological saline solution is injected subcutaneously as a placebo. The resulting changes in eye and body equilibrium function are examined by various equilibrium tests and compared with those induced adrenaline itself.2) This test showed in vertiginous patients with cranio-cervical injury two reactions of Type A and Type B. In Type A, placebo results in development ofr increase in ataxia, and the ataxia thus induced tends be similar to that induced by adrenaline. In Type B, saline solution has no significant effect on eye and body equilibrim.3) With reference to the results of our animal experiments and patients with cranio-cervical injury, we postulate that Type A is induced in the following manner; abnormal excitation of the temporal cortex, which is brought about by psychological stress, affets the hippocampus, particularly its adrenergic component through the neural linkage between the two parts of the brain mentioned above. Thus, over-stimulation of adrenergic component of the latter brain is induced, resulting in development or increase of disequilibrium of the eyes and body. This, of course, leads to teh appearance or increase of vertigo in patients with Type A.4) Type A is considered to be of psychosomatic origin, since this type of ataxia has the following characteristics : i) In patients with Type A, the patterns of ataxia by the above mentioned equilibrium test are specifically correlated with the locus of lesions in the equilibrium system. ii) In these patients, there is an alteration in types of ataxia in the course of treatment and moreover, this alteration appears in relation to psychological factors. iii) Type A is frequently observed in patients in a hysterical state of traumatic neurosis, whereas this type of ataxia is never seen in other types of mental diorders, such as neurosis and masked depression.5) With reference to the results of our animal experiments and patients with cranio-cervical injury, we postulate that the cerebellum, albeit not a primary neural element in production of vertigo of psychosomatic origin-nevertheless affects the adrenergic component related to the hippocampus, thus enhancing development of vertigo of this type.