Achados à prova calórica e canal semicircular acometido na vertigem posicional paroxística benigna

Abstract

OBJETIVO: Caracterizar os achados da prova calórica em pacientes com vertigem posicional paroxística benigna, segundo o canal semicircular comprometido. MÉTODOS: Foram analisados 1033 prontuários de pacientes submetidos à pesquisa de nistagmo posicional e de posicionamento e à eletronistagmografia. Os achados da prova calórica, de acordo com os canais semicirculares acometidos, foram submetidos à análise estatística. RESULTADOS: No comprometimento de canal posterior, houve prevalência de normorreflexia (p<0,0001); hiporreflexia prevaleceu sobre hiper-reflexia (p<0,0001) e preponderância direcional (p<0,0001), e hiper-reflexia prevaleceu sobre preponderância direcional (p<0,0001). No comprometimento de canal lateral, normorreflexia prevaleceu sobre hiporreflexia (p<0,0001) e hiper-reflexia (p<0,0001); hiporreflexia tendeu a prevalecer sobre hiper-reflexia (p=0,0771), e preponderância direcional não ocorreu. No comprometimento de canal anterior, normorreflexia prevaleceu sobre hiporreflexia (p<0,0001); hiper-reflexia e preponderância direcional não ocorreram. CONCLUSÃO: Na prova calórica de pacientes com vertigem posicional paroxística benigna, normorreflexia, hiporreflexia, hiper-reflexia ou preponderância direcional do nistagmo pós-calórico ocorrem em ordem decrescente de prevalência, quando há comprometimento do canal posterior; normorreflexia prevalece sobre hiporreflexia ou hiper-reflexia e hiporreflexia tende a prevalecer sobre hiper-reflexia, no comprometimento do canal lateral; normorreflexia prevalece sobre hiporreflexia, no comprometimento do canal anterior.

Frequência de alteração vestibular em bombeiros militares de Alagoas

“…Nevertheless, some publications showed that normoreflexia was more frequent than the sum of the remaining relative and absolute values 24,25 , in contrast to what was found in the present study, which is attributable to the established cutoff values.…”

“…The caloric test can show whether there is functional compromise in one or two labyrinths, in addition to contributing to formulating suitable therapeutic strategies for each case, although it is not aimed at identifying the etiology of vestibular disturbances 24 . It is important to underscore that the alterations observed in this study were identified only during this test, confirming what the authors reported in their investigation, since thermal stimulation was the most sensitive test, revealing vestibular dysfunctions in patients with specific complaints and without any abnormalities in other stages of vestibular assessment 25 .…”

“…Hyperreflexia frequency was lower and unilateral in the two cases presented, and no hyporeflexia or areflexia was found. The literature 13,24,25 contains conflicting caloric test results, given that a number of authors conducted their research before publication of the guideline suggested for standardizing temperature and cutoff values in Brazil 12 . This one of the most common symptoms in both sexes worldwide, occurring in 10% of the population and more frequent in adults and the elderly (more than 40% of adults report its occurrence at some time in their lives) 4 .…”

Vestibular evoked myogenic potentials and digital vectoelectro-nystagmography's study in patients with benign paroxysmal positional vertigo

“…Benign Paroxysmal Positional Vertigo (BPPV) is a fairly common vestibular disorder characterized by brief but intense episodes of rotational vertigo triggered by rapid movement of the head. The diagnosis of BPPV is primarily clinical and can be corroborated by the use of the Dix-Hallpike maneuver and otoneurological examination 3 4 5 .…”

“…Patients with BPPV patients may present with findings related to each affected channel and its corresponding effects on the results of caloric testing. The findings range from normal reflexes to hyperreflexia or hyporeflexia contralateral or ipsilateral to the side affected by BPPV 4 10 11 .…”