RESUMO
OBJECTIVE: Due the lack of data on the treatment of Vascular Vertigo and Dizziness, this study aimed to report how we managed and treated those outpatients according to the recently introduced American Heart Association and Stroke Association guidelines. METHODS: We conducted a longitudinal case series from May 2022 to February 2023. We included patients who met the Bárány Society's Vascular Vertigo and Dizziness classification and were eligible for therapy in accordance with the American Heart Association and Stroke Association guidelines, featuring aspects of the stroke group and transient attack group. RESULTS: Overall, 41 patients (51.2% female; median age 72 years) were enrolled; 10 (24.3%) had ischemic strokes, 30 (73.1%) had transient ischemic attack, and 1 (2.4%) had a probable isolated labyrinthine infarction. The patients received dual antiplatelet (48.7%), single antiplatelet therapy (48.7%), and anticoagulant therapy (2.4%). No new crises occurred in 95.2% of the patients, and the transient ischemic attack group showed a significant decrease in discomfort from imbalance on the visual analog scale. CONCLUSIONS: Antiplatelets and anticoagulants are safe and effective in treating Vascular Vertigo and Dizziness as they prevent new ischemic events and increase the flow of the posterior circulation, reducing vertigo/dizziness attacks and imbalance complaints.
Assuntos
Anticoagulantes , Tontura , Inibidores da Agregação Plaquetária , Vertigem , Humanos , Tontura/etiologia , Feminino , Masculino , Idoso , Vertigem/etiologia , Inibidores da Agregação Plaquetária/uso terapêutico , Pessoa de Meia-Idade , Anticoagulantes/uso terapêutico , Pacientes Ambulatoriais , Idoso de 80 Anos ou mais , Estudos Longitudinais , Ataque Isquêmico Transitório/complicações , AVC Isquêmico/complicações , AVC Isquêmico/tratamento farmacológicoRESUMO
BACKGROUND Superior semicircular canal dehiscence is an inner-ear pathology which presents with vertigo, disequilibrium, and hearing loss. Although the exact etiology of superior semicircular canal dehiscence is unknown, it is thought that an increase in middle-ear pressure disrupts a thin overlying temporal bone. Superior semicircular canal dehiscence is frequently seen in association with dehiscence of the tegmen tympani, which overlies the middle ear. Here, we present a case report of a 52-year-old Puerto Rican man with vertigo, dizziness, vomiting, and mild hearing loss associated with superior semicircular canal and tegmen tympani dehiscence after performing improper scuba diving techniques. CASE REPORT A 52-year-old Puerto Rican man presented to the emergency department with vertigo, dizziness, vomiting, and mild hearing loss in the right ear. The symptoms began shortly after scuba diving with inadequate decompression techniques on ascent. He was treated with recompression therapy with mild but incomplete improvement in symptoms. Bilateral temporal magnetic resonance imaging was suggestive of segmental dehiscence of the right superior semicircular canal and tegmen tympani. High-resolution computed tomography of the temporal bone confirmed right superior semicircular canal and tegmen tympani dehiscence with an intact left inner ear. CONCLUSIONS The increased inner-ear pressure that occurs during scuba diving can lead to dehiscence of the superior semicircular canal and tegmen tympani, causing vertigo and hearing loss. Performance of improper diving techniques can further increase the risk of dehiscence. Therefore, appropriate radiologic evaluation of the inner ear should be performed in such patients.
Assuntos
Mergulho , Perda Auditiva , Deiscência do Canal Semicircular , Masculino , Humanos , Pessoa de Meia-Idade , Tontura/complicações , Tontura/patologia , Deiscência do Canal Semicircular/complicações , Deiscência do Canal Semicircular/patologia , Mergulho/efeitos adversos , Canais Semicirculares/diagnóstico por imagem , Orelha Média/diagnóstico por imagem , Vertigem/etiologia , Vertigem/patologia , Perda Auditiva/complicações , Perda Auditiva/patologia , VômitoAssuntos
Ataxia , Vertigem , Humanos , Pré-Escolar , Vertigem/diagnóstico , Vertigem/etiologia , MarchaRESUMO
OBJECTIVES: The COVID-19 pandemic adversely affects the mental health of vertigo patients. Thus, this study aimed to investigate the effects of coronavirus anxiety, health anxiety, anxiety symptom levels, and demographic variables on vertigo and its severity in vertigo patients during the pandemic. METHODS: This cross-sectional study was conducted from May 15 to November 15, 2021. In total, 118 patients with vertigo and 82 healthy controls participated in the study. Besides demographic and clinical data, Coronavirus Anxiety Scale (CAS), Hospital Anxiety Depression Scale-Anxiety Subscale (HAD-A), and Short Health Anxiety Inventory (SHAI) were applied to all participants. Additionally, Vertigo Symptom Scale-Short Form (VSS-SF) was administered to vertigo patients. RESULTS: According to the findings, vertigo patients experienced higher levels of coronavirus anxiety, health anxiety, and anxiety disorder compared to the healthy controls. In vertigo patients, the rate of coronavirus anxiety was 20.3%, and the rate of anxiety disorder was 32.2%. Majority of the patients (80.5%) were found to have severe-level vertigo. Additionally, most of the patients (82.1%) reported that the severity of vertigo during the pandemic was higher than before the pandemic. CONCLUSIONS: The COVID-19 pandemic causes serious mental health problems in vertigo patients, and pathological levels of these problems increase the discomfort of vertigo. Therefore, psychological assessment should be considered in these patients, and required psychological support and guidance services should be provided.
Assuntos
COVID-19 , Humanos , COVID-19/complicações , Pandemias , Estudos Transversais , Depressão/psicologia , Ansiedade/etiologia , Ansiedade/psicologia , Transtornos de Ansiedade/epidemiologia , Vertigem/etiologiaRESUMO
Resumen El síndrome de mal de desembarque es un cuadro clínico de mareo y oscilaciones corporales persistente, descrito siglos atrás cuando los marineros llegaban a tierra después de navegar. Actualmente, se sabe que este cuadro clínico ocurre también al bajarse de cualquier medio de transporte, ya sea marítimo, aéreo o terrestre. Cuando el cuadro clínico tiene una duración de tres o más días, se denomina mal de desembarque persistente, y se asocia a cefalea y mayores niveles de ansiedad y síntomas depresivos. A continuación, presentamos el cuadro clínico de un paciente que consultó por mareo persistente posterior a un paseo en bote en el mar. Se discute diagnóstico y manejo terapéutico.
Abstract Mal de Debarquement is a clinical syndrome characterized by persistent self-motion dizziness and increased oscillatory body sway, that was described centuries ago after sailors landed in port. Nowadays, it is known that mal de debarquement could appear after any travel in a motion vehicle, including airplanes, ships and cars. When the duration of the symptoms lasts longer than three days, a persistent mal de debarquement is diagnosed, and it is associated with headache and higher levels of anxiety and depressive symptoms. Here, we present a clinical case of a persistent mal de debarquement that attended to the Otolaryngology clinics at the Clinical Hospital of the University of Chile after a boat trip in the sea. We discuss diagnosis and clinical management.
Assuntos
Humanos , Masculino , Adulto , Adulto Jovem , Vertigem/etiologia , Vertigem/terapia , Enjoo devido ao Movimento/etiologia , Enjoo devido ao Movimento/terapia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/terapia , SíndromeRESUMO
INTRODUCTION: Ménière's disease is a multifactorial disorder affecting the inner ear, characterized by episodes of spontaneous and recurrent vertigo, fluctuating hearing loss and tinnitus. Intratympanic gentamicin therapy has been used to reduce the intensity and frequency of attacks in intractable Ménière's disease, but it is associated with hearing loss. There is controversy regarding its efficacy and safety. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 13 systematic reviews that included 80 primary studies overall, of which three correspond to randomized trials. We concluded that intratympanic gentamicin may improve the control of vertigo, and result in little or no difference to tinnitus, but the certainty of the evidence is low. Furthermore, we are uncertain whether intratympanic gentamicin reduces hearing or the frequency of vertigo attacks as the certainty of the evidence has been assessed as very low.
INTRODUCCION: La enfermedad de Ménière es una anomalía del oído interno de etiología multifactorial, caracterizada por episodios de vértigo espontáneo y recurrente, hipoacusia fluctuante y tinnitus. La terapia con gentamicina intratimpánica para la enfermedad de Ménière ha sido utilizada buscando reducir la intensidad y frecuencia de las crisis, pero se ha asociado a pérdida auditiva, por lo que existe controversia respecto a su eficacia y seguridad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 13 revisiones sistemáticas que en conjunto incluyeron 80 estudios primarios, de los cuales tres corresponden a ensayos aleatorizados. Concluimos que la gentamicina intratimpánica podría reducir el control del vértigo y resultar en poca o nula diferencia sobre el tinnitus, pero la certeza de evidencia es baja. Además, no es posible establecer con claridad si el uso de gentamicina intratimpánica disminuye la audición o la frecuencia de los ataques de vértigo porque la certeza de la evidencia existente ha sido evaluada como muy baja.
Assuntos
Doença de Meniere , Zumbido , Gentamicinas/uso terapêutico , Humanos , Doença de Meniere/tratamento farmacológico , Revisões Sistemáticas como Assunto , Zumbido/tratamento farmacológico , Zumbido/etiologia , Vertigem/tratamento farmacológico , Vertigem/etiologiaRESUMO
Aim: Vestibular migraine is one of the most common vestibular disorders, which includes headache, photophobia, phonopobia and visual auras. Others as osmophobia are common but usually subregistered, and potentially would be involved in the vestibular migraine episodes. The aim of this study was to perform a search about the frequency and clinical interaction between vestibular migraine and osmophobia. Data search: A literature review search was conducted on PubMed, EBSCO, Scielo, Google Scholar and Bvsalud of published studies between 2011 and 2021 using the MeSH terms 'vertigo and olfaction disorders', 'dizziness and olfaction disorders', 'migraine disorders and olfaction disorders'. Study selection: 12 articles were found, where patients with diagnosis of vestibular migraine according to Barany Society, reported clinical symptoms and the prevalence of each symptom related was documented. Only two studies, presented relevant information about osmophobia and vestibular migraine Data extraction and results: From 277 individuals diagnosed with vestibular migraine in two observational studies, only 5%-12%, reported osmophobia. To date only one case report describe in extension the relationship between vestibular migraine and osmophobia. Conclusions: This symptom would be underdiagnosed and subregistered in individuals with vestibular migraine. Further studies are needed to determine this association.
Objetivo: La migraña vestibular, es uno de los tipos de alteraciones vestibulares periféricas más comunes, asociada a la presentación de síntomas como cefalea, fotofobia, fonofobia y auras visuales. Otros como la osmofobia, si bien son reconocidos en la práctica clínica, son usualmente subregistrados y potencialmente pueden relacionarse con la presencia de episodios de migraña vestibular. Se realizó una revisión de la literatura acerca de la frecuencia e implicaciones clínicas entre migraña vestibular y osmofobia. Fuentes de datos: La búsqueda bibliográfica en las bases de datos PubMed, EBSCO, Scielo, Google Scholar y Bvsalud de artículos publicados entre los años 2011 y 2021 con los términos 'vertigo and olfaction disorders', 'dizziness and olfaction disorders', 'migraine disorders and olfaction disorders'. Selección de estudios: Se encontraron 12 artículos donde se consignó la presencia de criterios diagnósticos de la Sociedad de Bárány, documentación de síntomas clínicos y porcentajes de presentación. De estos, únicamente 2 estudios en idioma inglés presentaron información relevante acerca de osmofobia y migraña vestibular. Extracción y síntesis de datos: De los 277 participantes diagnosticados con migraña vestibular participantes en dos estudios observacionales, sólo el 5% al 12% reportaron la presencia de osmofobia. Hasta el momento, sólo se conoce un reporte de caso que detalla en extensión la relación entre migraña vestibular y osmofobia. Conclusiones: La presencia de osmofobia podría estar sub-diagnosticada y sub registrada en pacientes con migraña vestibular. Se requieren más estudios a nivel clínico para determinar dicha asociación.
Assuntos
Transtornos de Enxaqueca , Doenças Vestibulares , Tontura/complicações , Tontura/diagnóstico , Cefaleia , Humanos , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Vertigem/etiologia , Doenças Vestibulares/complicações , Doenças Vestibulares/diagnósticoRESUMO
OBJECTIVE: To establish a functional connection between neck physical evaluations, dizziness discomfort and image findings among subjects diagnosed with proprioceptive cervical dizziness. METHODS: After exclusion of peripheral vestibular disorders, 20 subjects with proprioceptive cervical dizziness hypothesis were selected. A Visual Analogue Scale (VAS) was used to quantify pain and vertigo. The active neck Range of Motion (ROM) and the Muscle Strength (MS) of the neck region were examined. The manipulation of vertebral bodies by the Maitland method and imaging scan were performed. RESULTS: A positive correlation between pain and vertigo VAS scores was found. The ROM of the cervical spine was limited and vertebral joint movement was restricted, especially at C3 and C5. No loss of MS was noticed. CONCLUSIONS: Proprioceptive cervical dizziness is usually an exclusion diagnosis among episodic chronic vertigos. Characteristically, it is reported by patients as instability or vertigo in crises. It is directly related to the neck ache severity and worsens with neck movements. The common pattern on clinical examination includes restriction and pain during neck flexion without loss of MS. Reduction of joint mobility and pain are also observed, especially at C3 and C54 kHz.
Assuntos
Tontura , Pescoço , Vertigem , Vértebras Cervicais/fisiopatologia , Tontura/diagnóstico , Tontura/etiologia , Humanos , Pescoço/fisiopatologia , Cervicalgia/complicações , Cervicalgia/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Vertigem/diagnóstico , Vertigem/etiologiaRESUMO
Cervical vertigo is a common complication of atlantoaxial joint dislocation. However, there is no consensus on the effects of different therapies on the recovery of the patients suffering cervical vertigo. The objective of this randomized controlled trial was to investigate the effect of traction therapy on reducing cervical vertigo induced by atlantoaxial joint dislocation. A total of 96 patients were randomized to receive traction therapy or traditional therapy for two weeks. The overall clinical efficacy was measured based on the 30-point cervical vertigo symptom and function evaluation form. The therapeutic effects were also evaluated based on lateral atlantodental space (LADS), vertigo scale, neck and shoulder pain scale, headache scale, daily life and work scale, psychosocial adaptation scale, and quality of life. Compared with the traditional therapy group, the traction group demonstrated markedly higher overall clinical efficacy (P=0.038). Both the traction therapy group and the traditional therapy group showed significant decrease in LADS (P<0.001), but the traction therapy group had a greater reduction of LAD compared with the traditional group (P<0.01). Traction therapy consistently led to significantly greater relief of cervical vertigo symptoms, including dizziness, neck and shoulder pain, headache, inconvenience in daily living and work activities, impaired psychosocial adaptation, while improving quality of life. The efficacy of traction therapy for cervical vertigo surpasses that of traditional therapy, suggesting that traction therapy is potentially more clinically useful in treating these patients.