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      Trastornos vestibulares en pacientes menores de 20 años. Estudio descriptivo Translated title: Vestibular disorders in patients under 20 years of age. Descriptive study

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          Abstract

          RESUMEN Introducción y objetivo: el vértigo es un síntoma frecuente en la población adulta, pero mucho menos habitual en niños y adolescentes. Mientras que la etiología del vértigo se ha establecido con suficiente evidencia científica en adultos, el diagnóstico en la edad pediátrica no se ha descrito con la misma fuerza por una menor casuística. Los objetivos de este artículo son evaluar la prevalencia y características clínicas de los trastornos vestibulares en niños y adolescentes y realizar una revisión bibliográfica de los últimos estudios epidemiológicos al respecto. Método: nuestro estudio es observacional, retrospectivo, no aleatorizado y realizado en el servicio de Otorrinolaringología del Hospital General Universitario de Castellón. Incluimos 20 pacientes con edades comprendidas entre 18 meses y 20 años, que consultaron por alteraciones en el equilibrio a lo largo de 2 años (2017-2018). Resultados: la migraña vestibular (45%) fue el cuadro más frecuente en nuestra serie, seguido del vértigo paroxístico benigno de la infancia (30%). La enfermedad de Ménière, la neuritis vestibular o la paroxismia vestibular, fueron cuadros menos frecuentes. Conclusiones: el vértigo en niños y adolescentes es una queja relativamente común, pese a estar subestimado en la práctica clínica. Se trata de una patología de bastante importancia puesto que supone un problema que puede influir en el aprendizaje, concentración e, incluso, en la capacidad lectora. Aunque las causas más frecuentes de vértigo en la edad pediátrica son la migraña vestibular y el vértigo paroxístico de la infancia, las etiologías son muy numerosas. Por otro lado, la historia clínica y la exploración otoneurológica son esenciales en el diagnóstico de trastornos vestibulares infantiles. Y, por último, las pruebas de imagen son necesarios en aquellos pacientes sugestivos de centralidad al presentar clínica neurológica, cefaleas persistentes, o traumatismo craneoencefálico previo.

          Translated abstract

          SUMMARY: Introduction and objective: vertigo is a frequent symptom in the adult population, but much less common in children and adolescents. While the etiology of vertigo has been established with sufficient scientific evidence in adults, diagnosis at the age pediatric has not been described with the same strength due to a lower casuistry. The objectives of this article are to evaluate the prevalence and clinical characteristics of vestibular disorders in children and adolescents and conducting a literature review of the latest epidemiological studies on the matter. Method: our study is observational, retrospective, not randomized and carried out in the Otorhinolaryngology service of the General Hospital University of Castellón. We included 20 patients aged between 18 months and 20 years, who consulted for alterations in balance over 2 years (2017-2018). Results: Vestibular migraine (45%) was the most frequent condition in our study. series, followed by benign paroxysmal vertigo of childhood (30%). The disease of Ménière, vestibular neuritis or vestibular paroxysmia, were less frequent. Conclusions: Vertigo in children and adolescents is a relatively common complaint. common, despite being underestimated in clinical practice. It is a pathology of quite important since it is a problem that can influence the learning, concentration and even reading ability. Although the causes common causes of vertigo in children are vestibular migraine and vértigo paroxysmal of infancy, the etiologies are very numerous. On the other hand, the story clinical and otoneurological examination are essential in the diagnosis of disorders children's halls. And finally, radiological tests are necessary in those patients suggestive of centrality when presenting neurological symptoms, headaches persistent, or previous traumatic brain injury.

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          Most cited references23

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          Vestibular migraine: the most frequent entity of episodic vertigo

          Vestibular migraine (VM) is the most common cause of episodic vertigo in adults as well as in children. The diagnostic criteria of the consensus document of the International Bárány Society for Neuro-Otology and the International Headache Society (2012) combine the typical signs and symptoms of migraine with the vestibular symptoms lasting 5 min to 72 h and exclusion criteria. Although VM accounts for 7 % of patients seen in dizziness clinics and 9 % of patients seen in headache clinics it is still underdiagnosed. This review provides an actual overview on the pathophysiology, the clinical characteristics to establish the diagnosis, the differential diagnosis, and the treatment of VM.
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            Episodic vertigo related to migraine (90 cases): vestibular migraine?

            A retrospective study was conducted on 90 patients with episodic vertigo that could be related to migraine as the most probable pathomechanism. Since the majority of the patients did not fulfill the criteria of the International Headache Society (IHS) for basilar migraine, the diagnosis was substantiated by disease course, medical efficacy in treating (ergotamines) and preventing (metoprolol, flunarizine) attacks, ocular motor abnormalities in the symptom-free interval, and careful exclusion of the most relevant differential diagnoses, such as transient ischemic attacks, Menière's disease, and vestibular paroxysmia. The following clinical features were elaborated. The initial manifestation could occur at any time throughout life, with a peak in the fourth decade in men and a "plateau" between the third and fifth decades in women. The duration of rotational (78%) and/or to-and-fro vertigo (38%) could last from a few seconds to several hours or, less frequently, even days; duration of a few minutes or of several hours was most frequent. Monosymptomatic audiovestibular attacks (78%) occurred as vertigo associated with auditory symptoms in only 16%. Vertigo was not associated with headache in 32% of the patients. In the symptom-free interval 66% of the patients showed mild central ocular motor signs such as vertical (48%) and/or horizontal (22%) saccadic pursuit, gaze-evoked nystagmus (27%), moderate positional nystagmus (11%), and spontaneous nystagmus (11%). Combinations with other forms of migraine were found in 52%. Thus, migraine is a relevant differential diagnosis for episodic vertigo. According to the criteria of the IHS, only 7.8% of these patients would be diagnosed as having basilar migraine. However, to ensure that at least those presenting with monosymptomatic episodic vertigo (78% in our study) receive effective treatment, we propose the use of the more appropriate term "vestibular migraine."
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              Neuro-otological manifestations of migraine.

              Vestibulocochlear derangements have been studied in three groups of patients: 200 unselected patients with migraine (Series I), 80 migrainous patients referred because of their symptoms for full neuro-otological examination (Series II), and 116 patients with tension headache who served as controls (Series III). Significant differences were established between tension headache and migraine in respect of incidence and severity of symptoms and their time of onset in relation to the headache. In migraine, vestibulocochlear disturbances can occur as an aura, accompanying the headache or during headache-free periods, the highest incidence occurring during the headache. In Series I, 59 per cent reported vestibular and/or cochlear symptoms and these were of disabling severity in 5 per cent. Significantly, 50 per cent had a history of motion sickness and 81 per cent experienced phonophobia during the headache, the probable mechanism of which is discussed. Persisting vestibulocochlear derangements were found in 77.5 per cent of Series II, largely vestibular and of both central and peripheral origin. Involvement of the vertebrobasilar vascular system appears to be the most likely explanation. Possible links between Ménière's disease, benign paroxysmal vertigo and migraine are discussed.
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                Author and article information

                Journal
                orl
                Revista ORL
                Rev. ORL
                Ediciones Universidad de Salamanca (Salamanca, Salamanca, Spain )
                2444-7986
                December 2022
                : 13
                : 4
                : 297-307
                Affiliations
                [1] Castellón de la Plana orgnameHospital General Universitario de Castellón orgdiv1Servicio de Otorrinolaringología España
                Article
                S2444-79862022000500003 S2444-7986(22)01300400003
                10.14201/orl.28412
                c2cfce8e-7217-4ca9-942e-d499dd6c2b65

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 15 May 2022
                : 11 February 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 11
                Product

                SciELO Spain

                Categories
                Artículos originales

                pediatric age,paroxysmal vertigo of childhood,vestibular migrain,vértigo,vertigo,dizziness,mareo,edad pediátrica,vértigo paroxístico de la infancia,migraña vestibular

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