ABSTRACT
RESUMO Objetivo analisar a ocorrência do diagnóstico psiquiátrico e o uso de psicotrópicos em sujeitos com queixas vestibulares e relacionar a presença dessas condições aos resultados da vestibulometria. Método estudo quantitativo, observacional, transversal, com 131 pacientes, atendidos em um hospital universitário. Foram submetidos à anamnese, inspeção visual do meato acústico externo, provas de equilíbrio estático e dinâmico, Posturografia dinâmica foam laser e vectoeletronistagmografia computadorizada. Resultados amostra composta por 109 mulheres e 22 homens, com média de idade de 55 anos e nove meses. O tipo de tontura mais frequente foi vertigem, com presença de sintomas neurovegetativos. Observou-se expressiva porcentagem de queixa/diagnóstico psiquiátrico, bem como uso de psicotrópicos, sendo principalmente inibidores seletivos da recaptação da serotonina, seguidos dos benzodiazepínicos. Houve relação entre a presença de condições psiquiátricas e mulheres, alterações do equilíbrio estático e alterações nas posições III e VI do Teste de Organização Sensorial. Na vectoeletronistagmografia, houve relação entre a idade e a presença de nistagmo espontâneo de olhos fechados. Conclusão Constatou-se alta ocorrência de condições psiquiátricas entre pacientes com tontura, com uso de psicotrópicos maior que na população geral. Destaca-se a associação entre ansiedade/depressão e alterações nas posições de sobrecarga visual da posturografia dinâmica foam laser. No entanto, não foi observada relação entre essas condições e alterações nas provas da vectoeletronistagmografia.
ABSTRACT Purpose to analyze the occurrence of psychiatric diagnosis and the use of psychotropics medications in subjects with vestibular complaints and to relate the presence of these conditions to the results of vestibulometry. Methods quantitative, observational, cross-sectional study with 131 patients, treated in a university hospital. They were submitted to anamnesis, visual inspection of the external ear canal, static and dynamic balance tests, Foam laser dynamic posturography and Computerized Vectoelectronystagmography. Results sample composed of 109 women and 22 men, with average age of 55 years and nine months. The most common type of dizziness was vertigo, with the presence of neurovegetative signals. A significant percentage of psychiatric complaint/diagnosis was observed, as well as the use of psychotropic medications, mainly serotonin uptake inhibitors, followed by benzodiazepines. There was a relation between the presence of psychiatric complaints with the female gender, alterations of the static balance and alterations in the Sensorial Organization Test positions III and VI. In the Vectoelectronystagmography, there was a relation between age and the presence of spontaneous nystagmus. Conclusion There was a high occurrence of psychiatric complaint/diagnosis among patients with dizziness, with use of psychotropic medications substantially greater than the general population. The evaluation of postural balance revealed an association between anxiety/depression and alterations visual overload positions in the foam laser dynamic posturography. However, no relationship was found between these conditions and alterations in the Vectoelectronystagmography tests.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Psychotropic Drugs/adverse effects , Vestibular Function Tests/methods , Vertigo/chemically induced , Mood Disorders/drug therapy , Dizziness/chemically induced , Postural Balance/drug effects , Psychotropic Drugs/classification , Retrospective Studies , Mood Disorders/complicationsABSTRACT
The anesthetic technique through the greater palatine canal seeks to block the maxillary nerve in the pterygopalatine fossa and anesthetize a large area, including the pulp and periodontium of the arch in question. After applying this technique in a patient, it failed to obtain the expected result. The patient began to experience dizziness, nausea, vomiting and the sensation of fluid in the ear. She was evaluated in both the emergency room of the Hospital Parroquial de San Bernardo and at a private clinic without accurate diagnosis. Only symptomatic treatment was provided. The next day she was discharged with reduced symptoms, which disappeared completely during the day. We propose the hypothesis of a diffusion of the anesthetic solution into the middle and inner ear through the auditory tube. This diffusion would explain the vestibular symptoms and the absence of anesthesia in the expected areas. We carried out an anatomic correlation in cadavers, following the path of a needle from the palatal mucosa to the pharyngeal opening of auditory tube. We conclude that the vertiginous syndrome could be due to an incorrect application of the technique, with the needle entering the auditory tube and spreading the anesthetic solution into the middle ear.
La técnica anestésica vía canal palatino mayor tiene como objetivo abordar al nervio maxilar en la fosa pterigopalatina, anestesiando un gran territorio, incluyendo la pulpa y periodonto de la hemiarcada correspondiente. Después de haber aplicado esta técnica en una paciente y no obteniendo el resultado esperado, esta comenzó a experimentar vértigo, náuseas, sensación de líquido en el oído y vómitos. Fue evaluada en el servicio de urgencias del Hospital Parroquial de San Bernardo y en una Clínica Privada, sin lograr un diagnóstico preciso y realizando solo un tratamiento sintomático. Al día siguiente fue dada de alta con baja sintomatología, la cual desapareció totalmente durante el día. Se propone la hipótesis de una difusión del anestésico hacia el oído medio e interno mediante el tubo auditivo. Esto explicaría por un lado la sintomatología vestibular y por otro la ausencia de anestesia en los dientes y territorios esperados. Además se realizó una correlación anatómica en cadáveres, utilizando 8 hemicabezas conservadas y siguiendo el posible trayecto de la aguja desde la mucosa palatina hasta el orificio faríngeo de la tuba auditiva. Se concluyó que el síndrome vertiginoso experimentado por la paciente se pudo deber a una técnica fallida al nervio maxilar vía canal palatino mayor con ingreso de la aguja al tubo auditivo, difundiendo el anestésico hacia el oído medio.
Subject(s)
Humans , Female , Vertigo/chemically induced , Palate, Hard/anatomy & histology , Anesthesia, Dental/adverse effects , Maxillary Nerve/anatomy & histology , Anesthesia, Dental/methods , Nerve Block/adverse effects , Nerve Block/methodsABSTRACT
La anestesia regional combinada es utilizada frecuentemente como herramienta para el tratamiento del dolor postoperatorio. Los efectos secundarios de los opioides utilizados por esta vía son similares a los que se presentan luego de la administración sistémica. La aparición de vértigo con nistagmo vertical es un efecto adverso muy pocas veces descripto con el uso de morfina por vía intratecal, epidural o endovenosa. Comunicamos el caso de un paciente que presentó esta complicación en el postoperatorio de una nefrectomía parcial, luego de la administración de morfina intratecal, con resolución completa mediante el uso de naloxona endovenosa.
Combined regional anesthesia is frequently used as a tool for management of postoperative pain. The profile of side effects of the opioids used via this route is similar to those occurring after systemic administration. The onset of vertigo with vertical nystagmus is an adverse effect rarely described after the use of intrathecal, epidural or intravenous morphine. We report the case of a patient who presented this complication in the postoperative period of a partial nephrectomy, after the administration of intrathecal morphine, with complete resolution by intravenous naloxone.
Subject(s)
Aged , Humans , Male , Analgesics, Opioid/adverse effects , Morphine/adverse effects , Naloxone/therapeutic use , Narcotic Antagonists/therapeutic use , Nystagmus, Pathologic/chemically induced , Vertigo/chemically induced , Analgesics, Opioid/administration & dosage , Injections, Spinal , Morphine/administration & dosage , Nystagmus, Pathologic/drug therapy , Pain, Postoperative/drug therapy , Vertigo/drug therapyABSTRACT
Os autores fazem uma revisão de literatura sobre alterações do sistema otoneurológico, decorrente da ação de agentes químicos como solventes e metais pesados, na maioria das ocasiões por exposição no trabalho. Relatam dois casos de intoxicação ocupacional por mercúrio, comentando a importância dos exames complementares para o diagnóstico.