ABSTRACT
The benign paroxystic positional vertigo (BPPV) is defined by brief episodic vertigo attacks and accompanied by a rotary-linear nystagmus, triggered by head position changes and is always produced in that position. The theory that better explains the BPPV is canalithiasis: free-floating particles leave the utricular macula and enter one of the semicircular canals, producing an endolymphatic movement that stimulates the cupula and produces vertigo and nystagmus. The diagnosis is based on a typical clinical history, normal ear and neurological examination and provocation maneuvers, such as the Dix-Hallpike test, reproduce the vertigo attacks. The treatments are the liberatory maneuvers, such as the Epley maneuver which makes the vertigo disappear. We present two cases of vertigo with a compatible clinic history of BPPV, where the Dix-Hallpike maneuver confirmed the diagnosis. The treatment in both cases was the Epley maneuver.
Subject(s)
Vertigo/diagnosis , Vertigo/therapy , Child , Child, Preschool , Humans , Male , Physical Therapy ModalitiesABSTRACT
El vértigo posicional paroxístico benigno (VPPB) se define como la aparición de episodios bruscos de vértigo de breve duración, provocados por cambios de posición, acompañados de nistagmo y que se reproducen al adoptar la posición desencadenante. La teoría fisiopatológica que mejor explica las características clínicas y del nistagmo en las maniobras de provocación del VPPB es la canalitiasis: partículas otolíticas desprendidas de la mácula del utrículo penetrarían en el interior de un conducto semicircular; su desplazamiento al realizar determinados movimientos en el plano de ese conducto produce una corriente endolinfática que estimularía la cúpula originando la aparición de vértigo y nistagmo. El diagnóstico se basa en una historia clínica típica, una exploración otoneurológica normal y una reproducción de la crisis con las maniobras de provocación. El tratamiento a través de las maniobras de reposición permite la resolución del cuadro de forma rápida y sencilla. Presentamos dos casos de mareo vistos en nuestro servicio de urgencias. La sospecha clínica y la realización de la maniobra de Dix-Hallpike confirmaron el diagnóstico de VPPB. La maniobra de Epley resolvió el cuadro de manera rápida y definitiva
The benign paroxystic positional vertigo (BPPV) is defined by brief episodic vertigo attacks and accompanied by a rotary-linear nystagmus, triggered by head position changes and is always produced in that position. The theory that better explains the BPPV is canalithiasis: free-floating particles leave the utricular macula and enter one of the semicircular canals, producing an endolymphatic movement that stimulates the cupula and produces vertigo and nystagmus. The diagnosis is based on a typical clinical history, normal ear and neurological examination and provocation maneuvers, such as the Dix-Hallpike test, reproduce the vertigo attacks. The treatments are the liberatory maneuvers, such as the Epley maneuver which makes the vertigo disappear. We present two cases of vertigo with a compatible clinic history of BPPV, where the Dix-Hallpike maneuver confirmed the diagnosis. The treatment in both cases was the Epley maneuver
Subject(s)
Humans , Male , Child , Vertigo/complications , Vertigo/diagnosis , Nystagmus, Pathologic/complications , Nystagmus, Pathologic/diagnosis , Head Movements , Posture/physiology , Signs and Symptoms , Nystagmus, Physiologic/genetics , Nystagmus, Physiologic/physiology , Vertigo/therapy , Sensation Disorders/complications , Time FactorsABSTRACT
INTRODUCTION: Specific immunotherapy consists in administering increasing doses of antigen, to which the patient is sensitive, to determine a protective immune response. PATIENTS AND METHODS: A descriptive and retrospective review of 30 patients diagnosed of seasonal allergic rhinitis, all treated with specific immunotherapy. Data on age, gender, symptoms, prick test before and after the immunotherapy administration, drugs, efficacy and side effects, were recorded using the SPSS statistical program. RESULTS: 90% had moderated symptoms and 10% had severe symptoms and asthma. 33% were sensitized to grass pollen. 60% needed antihistamines and intranasal corticosteroids before the immunotherapy. In a lot of cases (80%) there were no side effects. The complete desensitization occurred in 53.3% and the reduction of symptoms in 73% of the cases. 54% of the patients didn't need treatment after specific immunotherapy. CONCLUSIONS: The specific immunotherapy is the only curative therapy. Sublingual therapy is one of the most accepted because is well tolerated, it uses a higher allergen concentration, it reduces the symptoms and the needs of drugs and side effects are uncommon.
Subject(s)
Allergens/administration & dosage , Immunotherapy , Rhinitis, Allergic, Seasonal/therapy , Administration, Sublingual , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pollen , Retrospective StudiesABSTRACT
Introducción: La inmunoterapia es la administración de dosis crecientes del antígeno responsable del proceso alérgico para determinar una tolerancia inmunológica adecuada. Pacientes y Métodos: Se realiza un estudio descriptivo, transversal y retrospectivo en 30 pacientes diagnosticados de rinitis alérgica estacional, tratados con inmunoterapia sublingual. Se analizan una serie de variables (edad, género, síntomas, test cutáneo pre y posvacunación, tratamientos, evolución y efectos secundarios) con el programa estadístico SPS-S. Resultados: El 90% presentaba síntomas moderados y el 10% síntomas severos y asma. Los alérgenos más frecuentes fueron las gramíneas (33,3%). El 60% delos pacientes precisaba antihistamínicos y corticoides tópicos prevacunación. En el 80% no hubo efectos secundarios. La desensibilización completa ocurrió en el 53,3% de los pacientes y en el 73% hubo una mejoría clínica. El 54% de los casos no precisaba tratamiento posvacunación. Conclusiones: La inmunoterapia ha demostrado ser el único tratamiento curativo, siendo la vía sublingual una de las más aceptadas, ya que usa mayor dosis de alergeno, es bien tolerada, disminuye la sintomatología y la necesidad de tratamiento y los efectos secundarios son mínimos
Introduction: Specific immunotherapy consists in administering increasing doses of antigen, to which the patientis sensitive, to determine a protective immune response. Patients and Methods: A descriptive and retrospective review of 30 patients diagnosed of seasonal allergic rhinitis, all treated with specific immunotherapy. Data on age, gender, symptoms, prick test before and after the immunotherapy administration, drugs, efficacy and side effects, were recorded using the SPS-S statistical program. Results: 90%had moderated symptoms and 10% had severe symptoms and asthma. 33% were sensitized to grass pollen. 60% needed antihistamines and intranasal corticosteroids before the immunotherapy. In a lot of cases (80%) there were no side effects. The complete desensitization occurred in 53,3% and the reduction of symptoms in 73% of the cases. 54% of the patients didnt need treatment after specific immunotherapy. Conclusions: The specific immunotherapy is the only curative therapy. Sublingual therapy is one of the most accepted because is well tolerated, it uses a higher allergen concentration, it reduces the symptoms and the needs of drugs and side effects are uncommon
