[Prevalence of headaches and medication use in patients with recurrent vertigo]. / Prevalencia de cefalea y consumo de fármacos en pacientes con vértigo recurrente.

Headache and episodic vertigo are common symptoms in adults. Migraine-related dizziness and vertigo is a clinical process that is difficult to assess because specific diagnostic criteria are lacking. Although studies have demonstrated a relationship between migraine and dizziness, the prevalence of headache among patients with episodic vertigo is underestimated. A clinical inventory was used to determine the prevalence of headache among 150 patients with episodic vertigo and the impact that dizziness had on the quality of life using an ordinal scale for disability. Patients were questioned about drug use and self-perceived effectiveness. Twenty-three percent of the patients experienced a severe problem that disabled them for work. The prevalence of headache was 68.6% (71% of women and 64% of men). Forty-five percent of patients with episodic vertigo and 44% with headache did not obtain any benefit from symptomatic treatment. A subset of patients suffered from migraine-related dizziness and vertigo and were able to control their balance disorder with migraine therapy.

Prevalencia de cefalea y consumo de fármacos en pacientes con vértigo recurrente / Prevalence of headache and medication use in patients with recurrent vertigo

La cefalea y el vértigo recurrente son trastornos muy frecuentes en la población adulta. El vértigo asociado a migraña es un proceso clínico difícil de clasificarpor la falta de criterios diagnósticos específicos. Aunque diversos estudios han demostrado la relación entre cefalea y mareo, la prevalencia de cefalea entre los pacientes con vértigo recurrente es subestimada. Se diseñó una encuesta clínica para determinar la prevalencia de cefalea entre 150 pacientes con vértigo recurrente, así como el impacto del vértigo en la calidad de vida mediante una escala ordinal de discapacidad. Se interrogó sobre el consumo de fármacos y la opinión de los pacientes sobre su efectividad. El 23.3 por ciento de los individuos presentó una incapacidad severa que le impedía trabajar. La prevalencia de cefalea resultó del 68.6 por ciento (71 por ciento de mujeres y 64 por ciento de hombres). Para el 45 por ciento de los pacientes con vértigo recurrente y el 44 por ciento de los que presentan cefalea, el tratamiento farmacológico realizado no aporta beneficio alguno en el control de los síntomas. Un grupo de estos pacientes presenta vértigo/mareo asociado a cefalea y posiblemente podría controlar el trastorno del equilibrio con fármacos antimigrañosos (AU)

Headache and episodic vertigo are common symptoms in adults. Migraine-related dizziness and vertigo is a clinical process that is difficult to assess because specific diagnostic criteria are lacking. Although studies have demonstrated a relationship between migraine and dizziness, the prevalence of headache among patients with episodic vertigo is underestimated. A clinical inventory was used to determine the prevalence of headache among 150 patients with episodic vertigo and the impact that dizziness had on the quality of life using an ordinal scale for disability. Patients were questioned about drug use and self-perceived effectiveness. Twenty-three percent of the patients experienced a severe problem that disabled them for work. The prevalence of headache was 68.6% (71% of women and 64% of men). Forty-five percent of patients with episodic vertigo and 44% with headache did not obtain any benefit from symptomatic treatment. A subset of patients suffered from migraine-related dizziness and vertigo and were able to control their balance disorder with migraine therapy (AU)

[Diagnosis of common causes of vertigo using a structured clinical history]. / Diagnóstico de causas frecuentes de vértigo mediante historia clínica estructurada.

The structured clinical history is the most sensitive test for diagnosing vertigo. Its diagnostic effectiveness on the first visit was analyzed and key signs and symptoms with high predictive value for common causes of vertigo were identified. One hundred outpatients who complained of dizziness or loss of balance were evaluated using a structured clinical interview. Each questionnaire was examined independently by three blinded investigators, who assigned a diagnosis and identified the elements of the history that figured most prominently in the diagnosis. The gold standard was defined as independent selection of the same diagnostic category by all three investigators. A first-visit diagnosis was obtained in 40% of patients (95% confidence interval 30-50%): 38% women and 42% men. Causes included benign positional paroxysmal vertigo (BPPV, 13 patients), headache-associated vertigo (9), Meniere disease (7), cervical vertigo (3), psychiatric dizziness (2), post-traumatic vertigo (2), vertebro-basilar transient ischemic attack (1), vestibular neuritis (1), convulsive seizure (1), and presyncope (1). The best predictors of BPPV were the precipitating mechanism (specificity [SP] 100%), positional nystagmus (sensitivity [SE] 90%, SP 63%), and the Dix-Hallpike test (SE 82%, SP 71%). Elements predictive of headache-associated vertigo were duration of the attack (minutes) and a personal history of headache (both, SP 100%). Other predictors were facial hypoesthesia (SE 92%, SP 47%) and associated neurological disease (SE 82%, SP 58%).

Diagnóstico de causas frecuentes de vértigo mediante historia clínica estructurada / Diagnosis of common causes of vertigo using a structured clinical history

La historia clínica estructurada es el test de mayor sensibilidad para el diagnóstico de vértigo. Se analiza su eficacia diagnóstico en la primera visita, identificándose los signos y síntomas clave que presentan un elevado valor predictivo para las causas comunes de vértigo. Cien pacientes ambulatorios cuyo síntoma principal era desequilibrio o mareo fueron evaluados mediante entrevista clínica estructurada. Cada cuestionario fue evaluado de forma ciega por 3 investigadores que asignaron un diagnóstico y los elementos de la historia que más contribuyeron a seleccionar ese diagnóstico. El estándar ideal se definió como la selección independiente de la misma categoría diagnóstica por los 3 investigadores. En la primera visita, se obtuvo un diagnóstico en el 40 por ciento (intervalo de confianza al 95 por ciento, 30-50 por ciento): 38 por ciento de mujeres y 42 por ciento de hombres. Las causas fueron vértigo posicional paroxístico benigno (VPPB, 13 pacientes), vértigo asociado a cefalea (9 pacientes), Enfermedad de Méniére (7), vértigo cervical (3), trastorno del equilibrio de origen psíquico (2), vértigo post-traumático (2), accidente isquémico transitorio vértebro-basilar (1), neuritis vestibular (1), crisis convulsiva (1) y presíncope (1). Los factores predictivos para VPPB fueron el mecanismo desencadenante (especificidad [El 100 por ciento), el nistagmo posicional (sensibilidad [S] 90 por ciento, E 63 por ciento) y el test de Dix- Halipike (S 82 por ciento, E 71 por ciento). Los factores predictivos para el vértigo asociado a cefalea fueron la duración de la crisis de minutos y el antecedente de cefalea (E 100 por ciento). Otros factores predictivos fueron la hipoestesia facial (S 92 por ciento, E 47 por ciento) y la presencia de enfermedad neurológica asociada (S 82 por ciento, E 58 por ciento) (AU)

The structured clinical history is the most sensitive test for diagnosing vertigo. Its diagnostic effectiveness on the first visit was analyzed and key signs and symptoms with high predictive value for common causes of vertigo were identified. One hundred outpatients who complained of dizziness or loss of balance were evaluated using a structured clinical interview. Each questionnaire was examined independently by three blinded investigators, who assigned a diagnosis and identified the elements of the history that figured most prominently in the diagnosis. The gold standard was defined as independent selection of the same diagnostic category by all three investigators. A first-visit diagnosis was obtained in 40% of patients (95% confidence interval 30-50%): 38% women and 42% men. Causes included benign positional paroxysmal vertigo (BPPV, 13 patients), headache-associated vertigo (9), Meniere disease (7), cervical vertigo (3), psychiatric dizziness (2), post-traumatic vertigo (2), vertebro-basilar transient ischemic attack (1), vestibular neuritis (1), convulsive seizure (1), and presyncope (1). The best predictors of BPPV were the precipitating mechanism (specificity [SP] 100%), positional nystagmus (sensitivity [SE] 90%, SP 63%), and the Dix-Hallpike test (SE 82%, SP 71%). Elements predictive of headache-associated vertigo were duration of the attack (minutes) and a personal history of headache (both, SP 100%). Other predictors were facial hypoesthesia (SE 92%, SP 47%) and associated neurological disease (SE 82%, SP 58%) (AU)

Effectiveness of a structured questionnaire for diagnosis of Menière's disease in the first visit.

A structured questionnaire of vertigo (SQV) was used to search patients with Menière's disease (MD) in the first visit. One-hundred consecutive outpatients that complained of dizziness or vertigo were studied. Diagnosis of MD was accepted if three investigators independently recorded it among a list of 29 diagnostic categories after reviewing the SQV. The AAO criteria for definite MD defined by the Committee on Hearing and Equilibrium after 10 months or more of follow-up were the gold standard to contrast questionnaire-based diagnosis. Seven patients were considered as MD with the SQV. The sensitivity (Sn), specificity (Sp) and positive predictive value of the SQV for definite MD were 80%, 97% and 57% respectively, being the false positive rate 3%. The probability for diagnosis of definite MD using the SQV in the first visit was 58% in a set up with a 5% of prevalence. The best predictor selected by all investigators was the presence of hearing loss (Sn 100%, Sp 85%, positive likelihood ratio 6.67). Because of the high specificity, the SQV of vertigo results a useful test to advance the diagnosis of definite MD.

[The treatment of benign paroxysmal positional vertigo of the lateral semicircular canal by positional manipulation]. / Tratamiento del vértigo posicional paroxístico benigno del conducto semicircular lateral mediante maniobra posicional.

A case of left horizontal-canal benign paroxysmal positional vertigo (HC-BPPV) in a woman with a 7-year history of episodic vertigo when turning over in bed is reported. The diagnosis was established with the patient lying down with her head raised 30 degrees with respect to the horizontal plane. Treatment with positional maneuvers (270 degrees contralateral head rotation in 3 steps) resolved the attacks. Positional testing failed to elicit symptoms 7 days, 14 days, 1 month, and 2 months after treatment. Four months after treatment, the patient remains asymptomatic. Published cases of HC-BPPV are discussed, as well as the differential diagnosis with posterior semicircular canal BPPV.

Cervical metastasis of occult papillary thyroid carcinoma associated with epidermoid carcinoma of the larynx.

An occult, laterocervical papillary thyroid carcinoma tissue was found in a functional neck dissection for larynx cancer. The patient was a 76-year-old man with a history of smoking and alcohol ingestion who presented with a supraglottic carcinoma of the larynx located at the laryngeal surface of the epiglottis, left aryepiglottic fold, band and left ventricle with extension to the left vocal cord. Light microscopy showed a lymph node with a fibrous stroma with lymphoid follicles that presented a total substitution of the parenchyma by a papillary thyroid carcinoma. Although examination of the thyroid gland by seriated sections did not reveal any neoplasm, we argue that the papillary thyroid tissue is metastatic.