ABSTRACT
BACKGROUND AND OBJECTIVES: One of the most common complaints physicians face is dizziness. Patients with dizziness may have an array of conditions, from benign vertigo to potentially fatal cardiac arrhythmias, and including diverse conditions such as Parkinson`s disease and hyponatremia. This is a systematic review of the classification of dizziness, aiming at a more efficient and comprehensive clinical management of the condition, prompted from the presentation of an actual clinical case. METHODS: A 63-year-old man, with a 1-year history of dizziness predominantly on walking, was presented. The complaint prompted a search of the Pubmed and Scielo databases, for flow-charts and systematizations of the approach to the condition. RESULTS: Some approaches were identified that were useful in primary care, chiefly Drachman`s 4-type classification, which minimizes diagnostic biases. The clinical case was then discussed according to the information found, and a sequence of physical examination maneuvers, to beimplemented whenever a patient with dizziness is seen, waspresented. CONCLUSION: Approaching a patient complaining of dizziness and making its differential diagnosis is a huge intellectual challenge to any physician. There are tools that allow for correct classification of the patients, reduce diagnostic biases, discourage incorrect treatments and reduce expenses...
JUSTIFICATIVA E OBJETIVOS: Uma das queixas mais prevalentes e que mais confunde médicos é a tontura. Esses pacientes podem ter desde vertigens benignas até arritmias cardíacas potencialmente fatais, passando ainda por condições tão diversas quanto a doença de Parkinson e a hiponatremia. Este estudo tem por objetivo apresentar uma revisão sistemática sobre as classificações das tonturas, de forma a permitir uma abordagem clínica mais eficiente e abrangente, a partir da apresentação de um caso clínico real. MÉTODOS: é apresentado um paciente de 63 anos com queixa de tontura há cerca de 1 ano, principalmente para caminhar. A partir do quadro, foi feita revisão sistemática da literatura no Pubmed e Scielo, buscando os fluxogramas e sistematizações disponíveis para a abordagem da tontura. RESULTADOS: foram encontradas algumas formas de abordagem da tontura, muito úteis em atenção primária e clínica médica, especialmente a classificação nas 4 categorias de Drachman, a qual minimiza os vieses diagnósticos. Por fim, foi exposto o desfecho e a discussão do caso, juntamente com uma sugestão de sequência de exame físico a ser realizada em todo paciente com tontura. CONCLUSÃO: Saber abordar essa queixa e realizar seu diagnóstico diferencial é um grande desafio intelectual ao médico de qualquer especialidade. Há ferramentas disponíveis que permitem enquadrar o paciente em categorias, evitando vieses diagnósticos, tratamentos incorretos e gastos desnecessários...
Subject(s)
Humans , Male , Middle Aged , Dizziness/classification , Dizziness/diagnosis , Dizziness/etiologyABSTRACT
Objectives: The aims of this study were to evaluate the length, morphology, and calcification patterns of the elongated stylohyoid process (ESP) on panoramic radiographs and to investigate the symptoms related to it. We then addressed the question: Is ESP a pathologic condition or a physiologic phenomenon? Materials and Methods: In this study, 207 stylohyoid complexes were evaluated based on length, radiographic appearance, and calcification pattern on panoramic radiographs. Similar to previous studies, we considered 30 mm as a threshold for elongation of the process. Complexes were classified into two groups based on length: ESP (greater than or equal to 30 mm) and normal (less than 30 mm). Clinical symptoms were evaluated by using a questionnaire and clinical examination. Data were analyzed by the Kolmogorov-Smilonov test, Mann-Whitney U test, and Spearman correlation. Results: The average length of the stylohyoid complex was 31.7 mm. The median was 30.0 mm and corresponded to the threshold for the ESP. The Spearman correlation between the length of the complex and age was 0.323 (P=0.0001). "Continuous" and "calcified outline" were the most frequent morphology and calcification pattern, respectively, for both groups. Clinical symptoms related to ESP were not detected. Conclusion: Classification of the stylohyoid complexes based on apparent length on panoramic radiographs in elongated and normal types appears to be incorrect. Considering that the radiographic appearance of the ESP and normal groups was similar and pathologic symptoms were not detected and that there was a relationship between age and length of the complex, elongation of this complex can be considered as a physiologic phenomenon.
Subject(s)
Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Calcification, Physiologic/physiology , Cephalometry , Child , Cross-Sectional Studies , Dizziness/classification , Female , Headache/classification , Humans , Male , Middle Aged , Radiography, Panoramic , Temporal Bone/pathology , Temporal Bone/diagnostic imaging , Young AdultABSTRACT
TEMA: impacto da tontura na qualidade de vida (QV) em idosos vestibulopatas crônicos. OBJETIVO: avaliar a associação entre o impacto da tontura na QV de idosos com disfunção vestibular crônica e variáveis demográficas e clínicas. MÉTODO: estudo prospectivo em que 120 idosos com disfunção vestibular crônica submeteram-se à versão brasileira do Dizziness Handicap Inventory (DHI). Foram utilizados os testes de Mann-Whitney, Kruskal-Wallis e Coeficiente de Correlação de Spearman para verificar a associação de QV e as variáveis demográficas e clínicas. RESULTADOS: ocorreram associações significantes entre a presença de tontura rotatória e não rotatória com o escore total do DHI (p = 0,010) e subescala física (p = 0,049) e funcional (p = 0,009); entre quedas recorrentes com o DHI total (p = 0,004) e subescalas física (p = 0,045), funcional (p = 0,010) e emocional (p = 0,011). Correlações significantes foram encontradas entre incapacidade funcional e o DHI total (ρ = + 0,557; p < 0,001) e subescalas física (ρ = + 0,326; p < 0,001), funcional (ρ = + 0,570; p < 0,001) e emocional (ρ = + 0,521; p(0,001). CONCLUSÕES: o impacto da tontura na QV é maior nos idosos com tontura rotatória e não rotatória, quedas recorrentes e incapacidade funcional.
BACKGROUND: dizziness impact on the quality of life (QoL) of elderly patients with chronic vestibular dysfunction. AIM: to evaluate the association between the impact of dizziness on the QoL of elderly patients with chronic vestibular dysfunction and demographic and clinical variables. METHOD: a prospective study. A hundred and twenty elderly patients with chronic vestibular dysfunction underwent the Brazilian version of the Dizziness Handicap Inventory (DHI). In order to verify the association between the QoL and the demographic and clinical variables, the following testes were used: Mann-Whitney, Kruskal-Wallis and Spearman's correlation coefficient. RESULTS: there were significant associations between the presence of rotating and non-rotating dizziness with the total score of the DHI (p = 0.010) and physical (p = 0.049) and functional (p = 0.009) subscales; between recurrent falls with total DHI (p = 0.004) and physical (p = 0.045), functional (p = 0.010) and emotional (p = 0.011) subscales. Significant correlations were found between functional incapacity and total DHI (r = + 0,557; p < 0.001) and physical (r = + 0,326; p < 0.001), functional (r = + 0,570; p < 0.001) and emotional (r = + 0,521; p < 0.001) subscales. CONCLUSIONS: the impact of dizziness on the QoL is higher in elderly patients with rotating and non-rotating dizziness, recurrent falls and functional incapacity.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Dizziness/physiopathology , Quality of Life , Vestibular Diseases/physiopathology , Accidental Falls/statistics & numerical data , Brazil , Chronic Disease , Dizziness/classification , Prospective Studies , Statistics, Nonparametric , Surveys and QuestionnairesABSTRACT
Os autores descrevem as principais causas de vertigem e síncope, bem como fornecem subsídios para avaliaçäo clínica destes pacientes. A abordagem multidisciplinar necessária à terapêutica, foge ao escopo deste trabalho.