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1.
Neurol India ; 69(5): 1241-1246, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34747791

RESUMO

Background: Dizziness is a typical manifestation of vestibular pathologies. Clinical studies have shown that it affects 1.82% of young adults to more than 30% older adults. Habituation and compensation are some traditional rehabilitation protocols. Objective: Yoga is also known to have a significant effect on vestibulopathy. Hence, a need arises to compare the above two maneuvers. Materials and Methods: Participants were recruited (n = 32) after screening using the Dix-Hallpike and head impulse test. They were then divided into two groups (n = 16). The first one, Group A, received yogasanas, and the second one, Group B, received gaze stabilization and habituation exercises for 4 days a week for 3 weeks. Pre- and post intervention outcome measures were taken using the motion sensitivity quotient (MSQ) score and Dizziness Handicap Inventory (DHI) scale. Results: In reducing symptoms of dizziness, the between-group comparison shows that Group A has shown greater improvement (12.37% ±1.43%) in MSQ and Group B has shown greater improvement (16.12 ± 3.56) in DHI. Within-group comparison shows that both the interventions are effective in reducing symptoms of dizziness (P < 0.05). Conclusion: Both gaze stabilization along with habituation exercises and yogasanas are effective in improving the symptoms of dizziness in patients with peripheral vestibular dysfunction. When compared between the groups, yogasanas had a superior hand in the MSQ score, whereas gaze stabilization and habituation exercises had a superior hand in the DHI scale.


Assuntos
Tontura , Vestíbulo do Labirinto , Idoso , Tontura/terapia , Terapia por Exercício , Habituação Psicofisiológica , Humanos , Vertigem , Adulto Jovem
2.
Sensors (Basel) ; 21(22)2021 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-34833641

RESUMO

Vertigo is a sensation of movement that results from disorders of the inner ear balance organs and their central connections, with aetiologies that are often benign and sometimes serious. An individual who develops vertigo can be effectively treated only after a correct diagnosis of the underlying vestibular disorder is reached. Recent advances in artificial intelligence promise novel strategies for the diagnosis and treatment of patients with this common symptom. Human analysts may experience difficulties manually extracting patterns from large clinical datasets. Machine learning techniques can be used to visualize, understand, and classify clinical data to create a computerized, faster, and more accurate evaluation of vertiginous disorders. Practitioners can also use them as a teaching tool to gain knowledge and valuable insights from medical data. This paper provides a review of the literatures from 1999 to 2021 using various feature extraction and machine learning techniques to diagnose vertigo disorders. This paper aims to provide a better understanding of the work done thus far and to provide future directions for research into the use of machine learning in vertigo diagnosis.


Assuntos
Inteligência Artificial , Tontura , Diagnóstico Diferencial , Tontura/diagnóstico , Humanos , Aprendizado de Máquina , Vertigem/diagnóstico
3.
Orv Hetil ; 162(47): 1891-1896, 2021 11 21.
Artigo em Húngaro | MEDLINE | ID: mdl-34801982

RESUMO

Összefoglaló. Bevezetés: A szédülés idoskorban gyakori panasz, amely jelentosen befolyásolja az életminoséget. Háttere sok esetben multifaktoriális, egyes esetekben azonban jól meghatározott ok kimutatható. Célkituzés: Kutatásunk célja az idoskori szédülo populáció panaszainak, valamint életminoségének felmérése volt. Anyag és módszer: Kutatásunkba 36 (13 férfi, 23 nobeteg, átlagéletkor ± SD, 72,78 év ± 4,6), Otoneurológiai Ambulanciánkon szédülés miatt vizsgált, 65 év feletti beteget vontunk be. Ok az általunk összeállított, panaszokkal és rizikófaktorokkal kapcsolatos kérdoív mellett a Dizziness Handicap Inventory-t is kitöltötték. Az utóbbi alapján meghatározható volt az életminoség-romlás, illetve annak mértéke. A statisztikai elemzést az IBM SPSS V24 szoftver segítségével végeztük, Mann-Whitney U-teszt és khi-négyzet-próba alapján. Minden esetben p<0,05 értéket tekintettünk szignifikáns különbségnek. Eredmények: A leggyakoribb diagnózisként a Ménière-betegséget, valamint a centrális vestibularis eltéréseket detektáltuk. A betegek visszajelzése alapján a szédülés volt a legdominánsabb tünet, amely a leggyakrabban órákig, illetve napokig tartott, és fele arányban volt forgó jellegu. Emellett a fülzúgás, a halláscsökkenés, valamint a vegetatív tünetek is dominánsak voltak. A leggyakoribb társbetegségek közül gyakoriságuk miatt kiemelendok a mozgásszervi, illetve szemészeti eltérések, a hypertonia, valamint a pszichiátriai betegségek. A betegek 77,8%-a jelzett valamilyen mértéku életminoség-romlást, és kiemelendo, hogy 30%-uk a súlyos kategóriába esett. A Dizziness Handicap Inventory kérdoívek alapján a fizikális, funkcionális, valamint emocionális részpontszámok hasonló értéket mutattak. Következtetés: Az idoskori szédülés lényeges a beteg romló életminosége szempontjából. A társuló komorbiditások mellett a háttérben álló vestibularis eltérések kizárása, illetve diagnosztizálása fontos feladat. Ennek függvényében tervezheto a terápia, amely kapcsán a kíséro tünetekre is fontos hangsúlyt fektetni. Így az érintett betegek életminosége javítható. Orv Hetil. 2021; 162(47): 1891-1896. INTRODUCTION: Vertigo is a common complaint in elderly, which has significant influence on the patients' quality of life. In many cases its background is complex, although, in some cases specific diagnosis can be made. OBJECTIVE: Our study aimed to analyze the symptoms and quality of life of old-age vertiginous population. MATERIAL AND METHOD: 36 patients (13 males, 23 females, mean age ± SD, 72.78 years ± 4.6) over 65 years, examined due to vertigo at our Neurotologic Department, were enrolled. A questionnaire including questions regarding the symptoms, risk factors, along with the Dizziness Handicap Inventory was used. Statistical analysis was carried out using IBM SPSS V24 software. Mann-Whitney U and chi square tests were used. Statistical significance was defined as p<0.05. RESULTS: Ménière's disease and central vestibular disorders were found as the most frequent diagnoses. Vertigo was the most tormenting symptom, which usually lasted for hours or days, and was defined as rotatory in 50%. Tinnitus, hearing loss and vegetative symptoms were also dominant. The most frequent comorbidities were musculoskeletal disorders, hypertension, ophthalmological diseases and psychiatric disorders. 77.8% of the patients have reported worsened quality of life, of which 30% was detected as severe. Based on the Dizziness Handicap Inventory, physical, functional and emotional scores showed similar results. CONCLUSION: Vertigo in elderly is important due to its influence on patients' quality of life. Besides comorbidities, the diagnosis of vestibular pathologies is of great importance. Therefore, therapy planning is possible, and patients' quality of life can be improved. Orv Hetil. 2021; 162(47): 1891-1896.


Assuntos
Hipertensão , Qualidade de Vida , Idoso , Tontura/etiologia , Feminino , Humanos , Masculino , Inquéritos e Questionários , Vertigem/etiologia
4.
J Prim Care Community Health ; 12: 21501327211030120, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34720013

RESUMO

BACKGROUND: The broad range of vestibular tests used to diagnose labyrinth diseases allows for a functional assessment of the vestibular system. Among the many tests performed, the caloric test is considered the gold standard by providing an objective measurement of the vestibular function for each labyrinth. OBJECTIVE: to correlate the different types of dizziness with the caloric test result. METHODS: a descriptive study was performed based on the previous records of vestibular tests performed on patients with body balance disorders evaluated at Audiology Service between 2000 and 2020. The variables evaluated were sex, age, hearing loss, tinnitus, and caloric test result. RESULTS: the sample was composed of 892 patients, 654 (73.4%) women, and 238 (26.6%) men. Normal results were obtained for 57.4% (N = 514) of the individuals, while peripheral disease 40.1% (N = 357), and central disease 2.5% (N = 21) accounted for the remaining. Complaint of vertigo was not common in central disorders (P = .02; OR = 0.17) and instability was associated with bilateral vestibular weakness (P = 0.02; OR = 5.92). Vertigo associated with tinnitus and/or hearing loss was more frequent in the caloric test with peripheral abnormality (P = 0.008). CONCLUSION: complaints of vertigo associated with tinnitus and/or hearing loss must be directed for clinical observation of unilateral peripheral lesion and instability to central disease or bilateral peripheral lesion.


Assuntos
Perda Auditiva , Vestíbulo do Labirinto , Testes Calóricos , Tontura/diagnóstico , Tontura/etiologia , Feminino , Perda Auditiva/diagnóstico , Humanos , Masculino , Vertigem/diagnóstico
5.
Acta Otorhinolaryngol Ital ; 41(5): 467-473, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34734583

RESUMO

Objective: The treatment of choice for Ménière disease (MD) aims at preventing severity and frequency of vertigo attacks. The purpose of this study was to evaluate the effectiveness of ventilation tube (VT) placement on vertigo control in patients affected by MD with no response to standard medical therapy. Methods: 76 consecutive outpatients diagnosed with definite MD who failed medical therapy received VT insertion at the Department of Otolaryngology Head and Neck Surgery, "Ospedale del Mare", Naples, Italy, with a 3-year follow up. Results: Over the long term, VT placement was effective in controlling vertigo in 61.8% of patients. In the control group treated with standard preventive care (SPC) alone, all patients continued to experience recurrent vertigo during the entire study. Comparison of survival curves by using the log-rank test shows that significant differences in survival exist between subjects treated with VT placement and the control sample (p = 0.001). Conclusions: Our long-term follow-up confirms that VT placement is an effective and safe management option in intractable definite MD, especially in the elderly or in those refusing more invasive treatments.


Assuntos
Doença de Meniere , Idoso , Animais , Tontura , Feminino , Cavalos , Humanos , Itália , Ventilação da Orelha Média , Vertigem
6.
Artigo em Chinês | MEDLINE | ID: mdl-34628805

RESUMO

The diagnostic criteria for "Vestibular Migraine of Childhood", "Probable Vestibular Migraine of Childhood" and "Recurrent Vertigo of Childhood" is put forth by the Committee for the Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification subgroup of the International Headache Society at the beginning of 2021. It provides directions for the diagnosis and treatment of these syndromes to international community of pediatricians, otolaryngologists, neurologists, neurosurgeons, neuro-otologists physiotherapists, neurophysiologists, and audiologists. The paper concludes the current situation and research progress of diagnosis and treatment of children vertigo diseases.


Assuntos
Transtornos de Enxaqueca , Doenças Vestibulares , Criança , Consenso , Tontura , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/terapia , Vertigem/diagnóstico , Vertigem/terapia , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/terapia
7.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 35(9): 784-787;795, 2021 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-34628829

RESUMO

Objective:To evaluate the efficacy and safety of topiramate and flunarizine hydrochloride in the prophylactic treatment of vestibular migraine prophylaxis. Methods:47 patients with confirmed or probable vestibular migraine(VM) treated at the vertigo clinic of our neurology department from August 2020 to April 2021 were reviewed, and 42 patients were finally included. They were divided into topiramate group (n=22) and flunarizine hydrochloride group (n=20). The two groups were treated with topiramate 50 mg daily and flunarizine hydrochloride 10 mg daily, respectively. The visual analogue scale, vertigo duration, vertigo frequency, and Dizziness Handicap Inventory (DHI) scores of patients with VM before and 3 months after treatment were compared. The anxiety screening scale (GAD-7) and depression screening scale (PHQ-9) were recorded to assess the improvement of patients' anxiety and depression, and the occurrence of adverse events. Results:Topiramate and flunarizine hydrochloride effectively reduced vertigo intensity, vertigo duration, and vertigo frequency in VM patients (P<0.05). Meanwhile, total DHI score, DHI physical (DHI-P), DHI emotional (DHI-E), DHI functional (DHI-F), PHQ-9 and GAD-7 were significantly decreased(P<0.05). Furthermore, topiramate was superior to flunarizine hydrochloride in reducing vertigo intensity, vertigo duration, vertigo frequency, DHI-P, and DHI-F, while there was no significant difference between two drugs in improving patients' mood(P>0.05). No serious adverse events were reported in either group. Conclusion:This study suggests that topiramate and flunarizine hydrochloride are safe and effective in the prevention of VM, and the daily dose of topiramate 50 mg is superior to the daily dose of flunarizine hydrochloride 10 mg. However, there was no significant difference between the two drugs in terms of mood improvement.


Assuntos
Flunarizina , Transtornos de Enxaqueca , Ansiedade , Flunarizina/uso terapêutico , Humanos , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/prevenção & controle , Topiramato/uso terapêutico , Vertigem/tratamento farmacológico , Vertigem/prevenção & controle
8.
J Int Adv Otol ; 17(5): 433-437, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34617895

RESUMO

OBJECTIVE: To evaluate the presence of anti-compensatory saccades (AcS) using the video head impulse test (vHIT) in the healthy inner ear in patients with vestibular neuritis (VN) during the acute and subacute stages of VN. METHODS: We retrospectively considered a chart review of 2420 patients evaluated for acute vestibular syndrome from 2016 to 2020 in the Cassino (Italy) clinic. Nine hundred fifty-four patients with acute onset of vestibular syndrome who received an instrumental otoneurological assessment within 24 hours from the onset of the symptoms, evaluated by simultaneously using a combination of vHIT, ocular vestibular-evoked myogenic potential (VEMP), and cervical VEMP, were included in the study. RESULTS: Thirty-two patients with superior VN that showed an altered horizontal canal function when tested with vHIT and quick AcS on the healthy side were enrolled. We found that all patients with VN, evaluated in the first 24 hours from the onset of the symptoms, showed AcS when their head was abruptly and passively turned toward the healthy inner ear side. At follow-up within 8 weeks from the first evaluation, 29 out of 32 patients did not show increased AcS. CONCLUSIONS: Our findings support the hypothesis that the AcS on the healthy side are a clinical sign of vestibular canal hypofunction or paresis in patients affected by the acute stage of VN.


Assuntos
Potenciais Evocados Miogênicos Vestibulares , Neuronite Vestibular , Teste do Impulso da Cabeça , Humanos , Reflexo Vestíbulo-Ocular , Estudos Retrospectivos , Vertigem , Neuronite Vestibular/diagnóstico
9.
J Int Adv Otol ; 17(5): 465-467, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34617900

RESUMO

Past studies have found an association between cochlear hydrops or early Meniere's disease and acute low-frequency hearing loss (ALHL) without vertigo. However, its mechanism remains unclear in some ALHL cases. This report presents a case of ALHL associated with iron-deficiency anemia (IDA). The patient was a 49-year-old female who had previously been treated with betamethasone for sudden hearing loss in the right ear. Eight months later, the symptoms recurred and cochlear hydrops was diagnosed. Isosorbide and betamethasone were administered orally, and intravenous hydrocortisone tapering was added 1 week later, but these treatments were ineffective. At the same time and subsequently, iron sucrose was intravenously administered for IDA, and the patient's hearing loss gradually resolved within 2 months. In view of the increase in serum hemoglobin levels after iron therapy, this might have been the most effective treatment in this case. The hearing loss could therefore be associated with the patient's IDA.


Assuntos
Anemia Ferropriva , Hidropisia Endolinfática , Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Anemia Ferropriva/complicações , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/tratamento farmacológico , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Vertigem
13.
Orv Hetil ; 162(43): 1744-1748, 2021 10 24.
Artigo em Húngaro | MEDLINE | ID: mdl-34689135

RESUMO

Összefoglaló. Az emlotumor miatt kezelt, majd gondozott beteget - több tünetmentes év után - fejfájás, szédülés, ataxia, megváltozott, furcsa viselkedés, emlékezetzavar és dezorientáció miatt neurológiai, majd belgyógyászati osztályokon vizsgálták. Az alapos kivizsgálás ellenére a tüneteit magyarázó organikus eltérést nem igazoltak, ugyanakkor már a kezdetektol felmerült a szomatizációs tünetképzés lehetosége, ezért pszichiátriai osztályos felvételére került sor. Az elvégzett vizsgálatok, illetve a klinikai kép regresszív állapotot valószínusítettek. Terápiás próbálkozásaink ellenére a páciens állapota romlott, végül a megismételt neurológiai vizsgálatok meningitis carcinomatosát igazoltak. Az esettel szemléltetni kívánjuk, hogy a beteg premorbid muködési nívója, személyiségstruktúrája hogyan képes befolyásolni az ellátószemélyzetet, milyen külso és belso konfliktusokat válthat ki. A diagnózishoz vezeto folyamat bemutatásával fel kívánjuk hívni a figyelmet az interdiszciplináris együttmuködés fontosságára. Orv Hetil. 2021; 162(43): 1744-1748. Summary. Our patient with known breast cancer in her past medical history was hospitalized - after several asymptomatic years - for headache, dizziness, ataxia, changed behaviour and disorientation. Thorough internal and neurologic investigations did not find any disease underlying her symptoms, therefore the possibility of somatization disorder was raised. Despite lege artis therapeutic interventions carried out on the psychiatry ward, the patient's condition deteriorated and repeated neurological examinations eventually revealed carcinomatous meningitis. With this case, we would like to illustrate how the patient's premorbid function level and personality features might influence the attitude and opinion of the health care personnel, and what kind of external and internal conflicts might be triggered. By presenting the complexity of the diagnostic work-up, we would like to emphasize the importance of interdisciplinary cooperation in the interest of our patients. Orv Hetil. 2021; 162(43): 1744-1748.


Assuntos
Leucemia , Carcinomatose Meníngea , Feminino , Humanos , Vertigem
14.
J Int Med Res ; 49(10): 3000605211053553, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34693781

RESUMO

There have been relatively few reports of bilateral internal auditory canal metastases of asymptomatic primary pulmonary adenocarcinoma presenting as unilateral sudden sensorineural hearing loss and vertigo. We report a case of a 60-year-old male patient who complained of sudden hearing loss in the right ear and vertigo. Upon a physical examination, no definite neurological signs or nystagmus were observed. Pure-tone audiometry showed deafness in the right ear at all frequencies and high-frequency sensorineural hearing loss in the left ear. The video head impulse test suggested bilateral vestibulopathy. Magnetic resonance imaging of the brain (with gadolinium contrast) revealed bilateral internal auditory canal enhancement and a variable-sized nodular and peripheral-enhancing lesion in the cerebrum and the right cerebellum. A computed tomographic and bronchoscopic biopsy identified asymptomatic primary pulmonary adenocarcinoma in the left upper lobe of the lungs. This is a rare report of bilateral internal auditory canal metastases in an asymptomatic patient with primary pulmonary adenocarcinoma who initially presented with symptoms of unilateral sudden sensorineural hearing loss with vertigo.


Assuntos
Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Audiometria de Tons Puros , Perda Auditiva Súbita/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Vertigem/etiologia
15.
BMC Neurol ; 21(1): 394, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34641808

RESUMO

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) is the most common functional vestibular disorder. A multisensory mismatch altered by psychological influences is considered to be an important pathophysiological mechanism. Increased cortical and subcortical excitability may play a role in the pathophysiology of PPPD. We hypothesized that decreased motion perception thresholds reflect one mechanism of the abnormal vestibular responsiveness in this disorder. We investigated the vestibular perception thresholds and the vestibular ocular reflex with a rotatory chair experiment to gain insights in the processing and adaption to vestibular provocation. METHODS: In this cross-sectional study 26 female PPPD patients and 33 healthy female age matched controls (HC) were investigated sitting in a motorized rotary chair shielded regarding visual and acoustic stimuli. The chair was rotated for 20 minutes with slowly increasing velocity to a maximum of 72°/s. We functionally tested motion perception thresholds and vegetative responses to rotation as well as vestibular-ocular reflex thresholds. We additionally investigated several psychological comorbidities (i.e. depression, anxiety, somatosensory amplification) using validated scores. Conventional dizziness scores were obtained to quantify the experienced dizziness and impact on daily life. RESULTS: PPPD patients showed a significant reduced vestibulo-perceptual threshold (PPPD: 10.9°/s vs. HC: 29.5°/s; p<0.001) with increased motion sensitivity and concomitant vegetative response during and after the chair rotation compared to healthy controls. The extent of increased vestibular sensitivity was in correlation with the duration of the disease (p=0.043). No significant difference was measured regarding nystagmus parameters between both groups. CONCLUSION: PPPD patients showed increased vegetative response as well as decreased vestibulo-perceptual thresholds which are related to disease duration. This is of interest as PPPD might be sustained by increased vestibular excitability leading to motion intolerance and induction of dizziness when exposed to movement.


Assuntos
Tontura , Doenças Vestibulares , Estudos Transversais , Feminino , Humanos , Percepção , Vertigem
16.
BMC Med Educ ; 21(1): 532, 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34649532

RESUMO

BACKGROUND: Vertigo and dizziness (VD) are among the most frequently seen symptoms in clinics and are important for medical students, especially for those in Chinese standardized residency training (SRT). The aim of our study was to examine the PAL method's feasibility in the clinical teaching of VD-related diseases for SRT students in China. METHODS: This is a randomized, controlled, multicenter study. A total of 228 residents were invited to participate in this study, of which 198 completed the program. The students were randomized into two groups, and VD-related diseases were taught using lecture-based learning (control group) or peer-assisted learning (PAL). An examination paper and a rating scale were used to evaluate students' performance in the mastery of VD-related theoretical knowledge and clinical skills, meanwhile students' perceptions, satisfaction, and risk of burnout were also analyzed using a questionnaire. Independent-samples t-test and chi-square analysis were performed to evaluate statistical significance for continuous variables and categorical variables, respectively, using SPSS 18.0 software. RESULTS: The PAL group performed better in mastering theoretical knowledge and clinical skills than the control group. And more students believed that PAL could help improve their personal qualities such as teamwork skills. However, more students reported that PAL increased the risk of burnout. CONCLUSIONS: PAL was a suitable and effective method in the clinical teaching of some specialized diseases, especially it was recommended for students who had gained initial knowledge and skills, such as Chinese SRT students. However, we should draw attention to the increased risk of burnout if PAL is intended to be widely used in clinical teaching. TRIAL REGISTRATION: ISRCTN registry, ISRCTN53773239 , 05/07/2021, retrospectively registered.


Assuntos
Educação de Graduação em Medicina , Internato e Residência , Estudantes de Medicina , China , Tontura , Humanos , Grupo Associado , Ensino , Vertigem/diagnóstico
17.
Nutrients ; 13(10)2021 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-34684646

RESUMO

Vestibular disorders may generate complex signs and symptoms, which may alter patients' balance and the quality of life. Dizziness and vertigo can strongly affect daily activities and relations. Despite the presence of conventional drugs, maneuvers, and surgery, another interesting therapeutic opportunity is offered by nutraceuticals. These molecules are often used in the treatment of dizziness and vertigo, but the rationale of their application is not always solidly demonstrated by the scientific evidence. Several substances have shown a variable level of efficacy/usefulness in this field, but there is lack of important evidence for most of them. From a medico-legal point of view, specific information must be provided to the patient regarding the efficacy and possibilities that the use of these preparations can allow. Administering the right nutraceutical to the proper patient is a fundamental clinical skill. Integrating conventional drug treatment with nutraceutical administration seems to be easy, but it may be difficult considering the (in part unexplored) pharmacodynamics and pharmacokinetics of nutraceuticals. The aim of the scientific community should be to elevate nutraceuticals to the same law and technical dignity of conventional drugs.


Assuntos
Suplementos Nutricionais , Legislação como Assunto , Vestíbulo do Labirinto/patologia , Suplementos Nutricionais/efeitos adversos , Tontura/etiologia , Humanos , Vertigem/etiologia
19.
Acta Med Port ; 34(6): 428-434, 2021 Jun 01.
Artigo em Português | MEDLINE | ID: mdl-34715950

RESUMO

INTRODUCTION: Vestibular disorders in pediatric patients is still a controversial subject but has gained relevance over the years. In recent studies, its prevalence varied between 0.7% and 15%. Nevertheless, the true prevalence can be underestimated given that its clinical presentation is expressed compared to adults; it can present as rotatory vertigo, but It can also cause vision complaints, headaches, motor delay, and learning disability. Although middle ear effusion is considered the main cause of vestibular dysfunction in this age group, other diagnoses should be considered. The aim of this study was to describe clinical features of the pediatric population referred to a subspecialist Otorhinolaryngology vertigo clinic in a tertiary hospital between 2013 and 2017. We also aimed to compare the results and carry out a literature about the most common causes, diagnostic features and treatment approach. MATERIAL AND METHODS: Clinical records of patients referred to a subspecialist Otorhinolaryngology vertigo clinic with suspicion of vestibular dysfunction aged between 0 and 18 years old were reviewed. Patients with middle ear effusion were excluded. RESULTS: Thirty-seven patients met the inclusion criteria. From these, 59% were female, with a mean age of 10.9 years old during the first consultation. The most common reason for referral was rotatory vertigo. Nausea and headache were also frequent complaints in our population. All patients performed audiometry; videonistagmography was performed in 41% of the cases; imaging studies were done in 59% of patients. The most common causes of vestibular dysfunction were vestibular migraine and benign paroxysmal vertigo of childhood (both in 27% of the cases), followed by vestibular neuritis (in 22% of the cases). DISCUSSION: Although our findings partially concur with the literature, compared with other specialist centers, the range of reasons for referral and of conditions is not as diverse, which may suggest that there is underdiagnosis of vestibular dysfunction in this age group. CONCLUSION: Vestibular dysfunction in the pediatric age can have several causes; pediatricians, neurologists, physiatrists, family doctors and otorhinolaryngologists must be aware of the different forms of presentation. Referral and evaluation protocols addressing pediatric patients should be created.


Assuntos
Transtornos de Enxaqueca , Doenças Vestibulares , Neuronite Vestibular , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos , Vertigem/diagnóstico , Vertigem/epidemiologia , Vertigem/etiologia , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/epidemiologia
20.
Artigo em Russo | MEDLINE | ID: mdl-34481445

RESUMO

A review of the current literature shows that the combined use of neurophysiological and structural-functional neuroimaging methods has significantly expanded the understanding of the mechanisms of migraine with vestibular dysfunction: functional and structural disorders were found in brain regions involved in multisensory vestibular control and Central vestibular processing. Analysis of numerous studies shows that epilepsy can also cause vestibular symptoms, they can occur both without epileptic markers, and in combination with epileptic paroxysms. In isolated epileptic vertigo, according to studies widely presented in the literature, epileptic activity was most often detected by EEG data in the temporal regions, to a lesser extent in the parietal regions. In these studies, neuroimaging findings of foci of reduced substance density were found, which could be a consequence of deafferentation, as well as violations of connections with the focus of neuronal activity. In the absence of structural abnormalities, numerous studies have shown using magnetic resonance spectroscopy, diffusion MRI, and PET that the physiological basis for impaired neuronal metabolism was a decrease in synaptic activity, a violation of maintaining the difference in membrane potentials on the surface of the hippocampus, or changes in neighboring tracts of the white matter of the brain.


Assuntos
Epilepsia , Transtornos de Enxaqueca , Epilepsia/diagnóstico por imagem , Neuroimagem Funcional , Humanos , Imageamento por Ressonância Magnética , Transtornos de Enxaqueca/diagnóstico por imagem , Neuroimagem , Vertigem/diagnóstico por imagem
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