Retrospective evaluation of patients consulted to the pediatric neurology department with dizziness/vertigo
Öz
Aim: Dizziness and vertigo in childhood are the most common causes for admission to hospital in pediatric practice with wide etiological spectrum. The aim of this study was to evaluate the demographic, clinical, laboratory findings and differential diagnosis of patients consulted to the pediatric neurology department in tertiary research and training hospital.
Materials and Methods: We retrospectively evaluated the data of 132 patients under the age of 18 who were consulted to Konya Training and Research Hospital pediatric neurology outpatient clinic between March 2018 and February 2019 with the complaint of dizziness.
Results: There were 83 female and 49 male (female/male ratio: 1.7) patients. The median age was 14 years. The most common etiological causes were orthostatic hypotension (55.3%), psychogenic vertigo (7.6%), sinusitis/mastoiditis/labyrinthitis (6.1%), migraine (6.1%) and benign paroxysmal vertigo (6.1%).
The most common symptoms that accompany the dizziness were headache (48.5%), loss of vision (40.9%) and syncope (18.9%). Brain magnetic resonance imaging was performed in 95% of the patients before or after consultation, and only 4.8% had neurological life-threatening conditions. The potential causes of life-threatening dizziness include hydrocephalus, cerebral arterial infarction and cardiogenic causes (arrhythmia and coronary artery disease) were detected in two patients each. All the patients who had life-threatening neurological dizziness were presented with additional signs or symptoms.
Conclusion: Benign etiological causes are common in children who require pediatric neurology consultation with dizziness and vertigo. However, in the presence of associated neurological and cardiological signs and symptoms, life-threatening conditions should be excluded, and unnecessary examinations should be avoided.
Anahtar Kelimeler
Dizziness vertigo migraine orthostatic hypotension magnetic resonance imaging.
Kaynakça
- Neuhauser HK, von Brevern M, Radtke A, et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology. 2005; 65: 898-904. Bisdorff A, Von Brevern M, Lempert T, et al. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res. 2009; 19: 1-13. Chu YT, Cheng L. Vertigo and dizziness in Chinese. Acta Neurol Taiwan. 2007; 16: 50-60.
- O'Reilly RC, Morlet T, Nicholas BD, et al. Prevalence of vestibular and balance disorders in children. Otol Neurotol. 2010; 31: 1441-4.
- Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, et al. Prevalence and diagnosis of vestibular disorders in children: A review. Int J Pediatr Otorhinolaryngol 2014; 78: 718-24.
- Sloane PD, Coeytaux RR, Beck RS, et al. Dizziness: state of the science. Ann. Intern. Med. 2001; 134: 823-32.
- Ricci F, De Caterina R, Fedorowski A. Orthostatic hypotension: Epidemiology, prognosis, and treatment. J Am Coll Cardiol. 2015; 66: 848-60.
- Jahn K, Langhagen T, Schroeder AS, et al. Vertigo and dizziness in childhood-update on diagnosis and treatment. Neuropediatrics 2011; 42: 129-34. Pavlou M, Whitney S, Alkathiry AA, et al. The Pediatric Vestibular Symptom Questionnaire: A Validation Study. J Pediatr. 2016; 168: 171-7. Humphriss RL and Hall AJ. Dizziness in 10 year old children: an epidemiological study. Int. J. Pediatr. Otorhinolaryngol. 2011; 75: 395-400.
- Li CM, Hoffman HJ, Ward B, et al. Epidemiology of Dizziness and Balance Problems in Children in the United States: A Population-Based Study. J Pediatr. 2016; 171: 240-7. Abu-Arafeh I, Russell G. Paroxysmal vertigo as a migraine equivalent in children: a population-based study. Cephalalgia. 1995; 15: 22-5.
- Basser LS. Benign paroxysmal vertigo of childhood (a variety of vestibular neuronitis). Brain 1964; 87: 141-52. Ravid S, Bienkowski R, Eviatar L. A simplified diagnostic approach to dizziness in children. Pediatr Neurol. 2003; 29: 317-20.
- Raucci U, Vanacore N, Paolino MC, et al. Vertigo/dizziness in pediatric emergency department: Five years' experience. Cephalalgia. 2016; 36: 593-8.
- Batu ED, Anlar B, Topçu M, et al. Vertigo in childhood: a retrospective series of 100 children. Eur J Paediatr Neurol. 2015; 19: 226-32.
- Balatsouras DG, Kaberos A, Assimakopoulos D, et al. Etiology of vertigo in children. Int J Pediatr Otorhinolaryngol 2007; 71: 487-94.
- Gruber M, Cohen-Kerem R, Kaminer M, et al. Vertigo in children and adolescents: Characteristics and outcome. Scientific World Journal 2012:109624.
- Erbek SH, Erbek SS, Yilmaz I, et al. Vertigo in childhood: A clinical experience. Int J Pediatr Otorhinolaryngol 2006; 70: 1547-54.
- Choung YH, Park K, Moon SK, et al. Various causes and clinical characteristics in vertigo in children with normal eardrums. Int J Pediatr Otorhinolaryngol. 2003; 67: 889-94.
- Drigo P, Carli G, Laverda AM. Benign paroxysmal vertigo of childhood. Brain Dev. 2001; 23: 38-41.
- Langhagen T, Schroeder AS, Rettinger N, et al. Migraine-related vertigo and somatoform vertigo frequently occur in children and are often associated. Neuropediatrics 2013; 44: 55-8.
- Riina N, Ilmari P, Kentala E. Vertigo and imbalance in children: a retrospective study in a Helsinki University otorhinolaryngology clinic. Arch. Otolaryngol. Head Neck Surgery. 2005; 131: 996-1000.
- Kroenke K, Hoffman RM and Einstadter D. How common are various causes of dizziness? A critical review. Southern Med. J. 2000; 93: 160-7.
- Chawla N, Olshaker JS. Diagnosis and management of dizziness and vertigo. Med Clin North Am. 2006; 90: 291-304.
Çocuk nöroloji bölümüne baş dönmesi şikâyeti ile konsülte edilen hastaların retrospektif değerlendirmesi
Öz
Amaç: Çocukluk çağında baş dönmesi geniş etiyolojik spektrumu ile pediatri pratiğinde en sık hastaneye başvuru nedenlerinden birisidir. Bu çalışmada üçüncü basamak eğitim araştırma hastanesi çocuk nöroloji polikliniğine baş dönmesi şikâyetiyle konsülte edilen hastaların demografik özellikleri, ayırıcı tanısı, klinik ve laboratuvar bulguları ile değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Konya Eğitim ve Araştırma Hastanesi çocuk nöroloji polikliniğine Mart 2018 - Şubat 2019 tarihleri arasında baş dönmesi şikayeti ile konsülte edilen 18 yaşından küçük 132 hastanın verilerini retrospektif olarak değerlendirdik.
Bulgular: Hastaların 83’ü kız, 49’u erkek (kız/erkek oranı:1,7)’di. Ortanca yaş 14’tü. En sık etiyolojik nedenler; ortostatik hipotansiyon (%55,3), psikojenik vertigo (%7,6), sinüzit/mastoidit/labirintit (%6,1), migren (%6,1) ve benign paroksismal vertigo (%6,1)’ydu. Baş dönmesine eşlik eden en sık şikayetler; baş ağrısı (%48,5), göz kararması (%40,9) ve senkoptu (%18,9). Hastaların %95'ine konsültasyon öncesi veya sonrası beyin manyetik rezonans görüntüleme yapılmıştı ve sadece %4,8'inde nörolojik hayatı tehdit eden durum saptandı. Olası yaşamı tehdit eden baş dönmesi nedenleri arasında; hidrosefali, serebral arteriyel enfarktüs ve kardiyojenik nedenler (aritmi ve koroner arter hastalığı) ikişer hastada tespit edildi. Hayatı tehdit eden nörojenik baş dönmesine sahip tüm hastalar ek nörolojik belirti veya bulgulara sahipti.
Sonuç: Baş dönmesi yakınması ile pediatrik nöroloji konsültasyonu sağlanan çocuklarda benign etiyolojik nedenler sıktır. Ancak ilişkili nörolojik ve kardiyolojik ek belirti ve bulguların varlığında, yaşamı tehdit eden durumların dışlanması ve gereksiz tetkikten kaçınılması gerekmektedir
Anahtar Kelimeler
Baş dönmesi vertigo migren ortostatik hipotansiyon manyetik rezonans görüntüleme.
Kaynakça
- Neuhauser HK, von Brevern M, Radtke A, et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology. 2005; 65: 898-904. Bisdorff A, Von Brevern M, Lempert T, et al. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res. 2009; 19: 1-13. Chu YT, Cheng L. Vertigo and dizziness in Chinese. Acta Neurol Taiwan. 2007; 16: 50-60.
- O'Reilly RC, Morlet T, Nicholas BD, et al. Prevalence of vestibular and balance disorders in children. Otol Neurotol. 2010; 31: 1441-4.
- Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, et al. Prevalence and diagnosis of vestibular disorders in children: A review. Int J Pediatr Otorhinolaryngol 2014; 78: 718-24.
- Sloane PD, Coeytaux RR, Beck RS, et al. Dizziness: state of the science. Ann. Intern. Med. 2001; 134: 823-32.
- Ricci F, De Caterina R, Fedorowski A. Orthostatic hypotension: Epidemiology, prognosis, and treatment. J Am Coll Cardiol. 2015; 66: 848-60.
- Jahn K, Langhagen T, Schroeder AS, et al. Vertigo and dizziness in childhood-update on diagnosis and treatment. Neuropediatrics 2011; 42: 129-34. Pavlou M, Whitney S, Alkathiry AA, et al. The Pediatric Vestibular Symptom Questionnaire: A Validation Study. J Pediatr. 2016; 168: 171-7. Humphriss RL and Hall AJ. Dizziness in 10 year old children: an epidemiological study. Int. J. Pediatr. Otorhinolaryngol. 2011; 75: 395-400.
- Li CM, Hoffman HJ, Ward B, et al. Epidemiology of Dizziness and Balance Problems in Children in the United States: A Population-Based Study. J Pediatr. 2016; 171: 240-7. Abu-Arafeh I, Russell G. Paroxysmal vertigo as a migraine equivalent in children: a population-based study. Cephalalgia. 1995; 15: 22-5.
- Basser LS. Benign paroxysmal vertigo of childhood (a variety of vestibular neuronitis). Brain 1964; 87: 141-52. Ravid S, Bienkowski R, Eviatar L. A simplified diagnostic approach to dizziness in children. Pediatr Neurol. 2003; 29: 317-20.
- Raucci U, Vanacore N, Paolino MC, et al. Vertigo/dizziness in pediatric emergency department: Five years' experience. Cephalalgia. 2016; 36: 593-8.
- Batu ED, Anlar B, Topçu M, et al. Vertigo in childhood: a retrospective series of 100 children. Eur J Paediatr Neurol. 2015; 19: 226-32.
- Balatsouras DG, Kaberos A, Assimakopoulos D, et al. Etiology of vertigo in children. Int J Pediatr Otorhinolaryngol 2007; 71: 487-94.
- Gruber M, Cohen-Kerem R, Kaminer M, et al. Vertigo in children and adolescents: Characteristics and outcome. Scientific World Journal 2012:109624.
- Erbek SH, Erbek SS, Yilmaz I, et al. Vertigo in childhood: A clinical experience. Int J Pediatr Otorhinolaryngol 2006; 70: 1547-54.
- Choung YH, Park K, Moon SK, et al. Various causes and clinical characteristics in vertigo in children with normal eardrums. Int J Pediatr Otorhinolaryngol. 2003; 67: 889-94.
- Drigo P, Carli G, Laverda AM. Benign paroxysmal vertigo of childhood. Brain Dev. 2001; 23: 38-41.
- Langhagen T, Schroeder AS, Rettinger N, et al. Migraine-related vertigo and somatoform vertigo frequently occur in children and are often associated. Neuropediatrics 2013; 44: 55-8.
- Riina N, Ilmari P, Kentala E. Vertigo and imbalance in children: a retrospective study in a Helsinki University otorhinolaryngology clinic. Arch. Otolaryngol. Head Neck Surgery. 2005; 131: 996-1000.
- Kroenke K, Hoffman RM and Einstadter D. How common are various causes of dizziness? A critical review. Southern Med. J. 2000; 93: 160-7.
- Chawla N, Olshaker JS. Diagnosis and management of dizziness and vertigo. Med Clin North Am. 2006; 90: 291-304.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2020 |
| Gönderilme Tarihi | 2 Ağustos 2019 |
| Yayımlandığı Sayı | Yıl 2020Cilt: 59 Sayı: 2 |
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