Tontura e vertigem Flashcards
Quais os dados fundamentais frente a um paciente com vertigem?
When a patient presents with dizziness, the fi rst step is to delineate more precisely the nature of the symptom. Vertigo, an illusion of self or environmental motion, implies asymmetry of vestibular inputs from the two labyrinths or in their central pathways and is usually acute. The history should focus closely on other features, including whether dizziness is paroxysmal or has occurred only once, the duration of each episode, any provoking factors, and the symptoms that accompany the dizziness. auses of dizziness can be divided into episodes that last for seconds, minutes, hours, or days. Symptoms such as double vision, numbness, and limb ataxia suggest a brainstem or cerebellar lesion.
Quais as etapas fundamentais da avaliação de um paciente com vertigem?
Particular focus should be given to assessment of eye movements, vestibular function, and hearing.
Except in the case of acute vestibulopathy (e.g., vestibular neuritis), if primary position nystagmus is easily seen in the light, it is probably due to a central cause. Two forms of nystagmus that are characteristic of lesions of the cerebellar pathways are vertical nystagmus with downward fast phases (downbeat nystagmus) and horizontal nystagmus that changes direction with gaze (gaze-evoked nystagmus).
pecialists find that the most useful bedside test of peripheral vestibular function is the head impulse test, in which the vestibuloocular reflex (VOR) is assessed with small-amplitude (approximately 20 degrees) rapid head rotations; beginning in the primary position, the head is rotated to the left or right while the patient is instructed to fixate on the examiner’s face. If the VOR is deficient, a catch-up saccade is seen at the end of the rotation.
All patients with episodic dizziness, especially if it is provoked by positional change, should be tested with the Dix-Hallpike maneuver. The patient begins in a sitting position with the head turned 45 degrees; holding the back of the head, the examiner then gently lowers the patient into a supine position with the head extended backward by about 20 degrees, and observes for nystagmus; after 30 s the patient is raised to the sitting position and after a 1-min rest the procedure is repeated with the head turned to the other side. Use of Frenzel eyeglasses (self-illuminated goggles with convex lenses that blur the patient’s vision but allow the examiner to see the eyes greatly magnified) can improve the sensitivity of the test.
Qual o manejo da neurite vestibular?
Most patients with vestibular neuritis recover spontaneously, but glucocorticoids can improve outcome if administered within 3 days of symptom onset. Antiviral medications are of no proven benefit unless there is evidence to suggest herpes zoster oticus (Ramsay Hunt syndrome). Vestibular suppressant medications may reduce acute symptoms but should be avoided after the first several days as they may impede central compensation and recovery. Patients should be encouraged to resume a normal level of activity as soon as possible, and directed vestibular rehabilitation therapy may accelerate improvement.
Como prescrever os principais antivertiginosos?
Antihistamines
Meclizine 25–50 mg 3 times daily
Dimenhydrinate50 mg 1–2 times daily
Promethazine 25 mg 2–3 times daily (also can be given rectally and IM)
Benzodiazepines
Diazepam 2.5 mg 1–3 times daily
Clonazepam 0.25 mg 1–3 times daily
Quais os tratamentos específicos das vestibulopatias periféricas?
- VPPB: Repositioning maneuvers
- Doença de Meniere: Diuretics and/or lowsodium (1 g/d) diet
- Neurite vestibular: Methylprednisoloneg 100 mg daily days 1–3; 80 mg daily days 4–6; 60 mg daily days 7–9; 40 mg daily days 10–12; 20 mg daily days 13–15; 10 mg daily days 16–18, 20, 22
- Enxaqueca migranosa: Antimigrainous drugs
- Vertigem psiquiátrica: Selective serotonin reuptake inhibitors
Quais as tres perguntas em um doente com tontura?
In evaluating patients with dizziness, questions to consider include the following: (1) is it dangerous (e.g., arrhythmia, transient ischemic attack/stroke)? (2) is it vestibular? and (3) if vestibular, is it peripheral or central? A careful history and examination often provide enough information to answer these questions and determine whether additional studies or referral to a specialist is necessary
Quais as causas de hipofuncao vestibular bilateral?
Bilateral vestibular hypofunction may be (1) idiopathic and progressive, (2) part of a neurodegenerative disorder, or (3) iatrogenic, due to medication ototoxicity (most commonly gentamicin or other aminoglycoside antibiotics). Other causes include bilateral vestibular schwannomas (neurofibromatosis type 2), autoimmune disease, meningeal-based infection or tumor, and other toxins. It also may occur in patients with peripheral polyneuropathy; in these patients, both vestibular loss and impaired proprioception may contribute to poor balance. Finally, unilateral processes such as vestibular neuritis and Ménière’s disease may involve both ears sequentially, resulting in bilateral vestibulopathy.
Quais as três categorias dos sintomas da síndrome vestibular?
Vestibular disorders have symptoms and signs in three categories: (1) vertigo, the subjective appreciation or illusion of movement; (2) nystagmus, a vestibulo-oculomotor sign; and (3) poor standing balance, an impairment of vestibulospinal function.
Quais os achados da síndrome de Wallemberg?
Occlusion of the anterior inferior cerebellar artery produces variable degrees of infarction because the size of this artery and the territory it supplies vary inversely with those of the PICA. The principal symptoms include: (1) ipsilateral deafness, facial weakness, vertigo, nausea and vomiting, nystagmus, tinnitus, cerebellar ataxia, Horner’s syndrome, and paresis of conjugate lateral gaze; and (2) contralateral loss of pain and temperature sensation. An occlusion close to the origin of the artery may cause corticospinal tract signs
