1
|
Teggi R, Colombo B, Familiari M, Cangiano I, Bussi M, Filippi M. Phenotypes, bedside examination, and video head impulse test in vestibular migraine of childhood compared with probable vestibular migraine and recurrent vertigo in childhood. Front Pediatr 2023; 11:1152928. [PMID: 37377754 PMCID: PMC10291096 DOI: 10.3389/fped.2023.1152928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Vestibular impairment and vertigo in the pediatric population have an estimated prevalence ranging between 0.4% and 5.6% and are a topic of interest in recent years. The Bárány Society has recently reclassified migraine-related vertigo syndromes as vestibular migraine of childhood (VMC), probable vestibular migraine of childhood (probable VMC), and recurrent vertigo of childhood (RVC). Methods Applying the criteria established by the Bárány Society, we retrospectively analyzed data on 95 pediatric patients suffering from episodic vertigo that were recruited from 2018 to 2022. In applying the revised criteria, 28 patients had VMC, 38 had probable VMC, and 29 had RVC. Results Visuo-vestibular symptoms (external vertigo) or internal vertigo were reported by 20 of 28 VMC patients (71.4%) compared to 8 of 38 probable VMC patients (21%) (P < .001). None of the RVC patients reported external vertigo. Duration of vertigo was demonstrably longer in the VMC patients than in the probable VMC (P < .001) and RVC (P < .001) patients. Cochlear symptoms were reported by 28.6% of VMC patients and by 13.1% of probable VMC patients. No cochlear symptoms were reported by any RVC patients. Familial cases for headache and episodic vertigo showed no significant difference between groups. Discussion The most frequent finding during bedside examination in all three groups was central positional nystagmus. Differences in the duration of attacks and in accompanying symptoms may underline different pathophysiological mechanisms.
Collapse
Affiliation(s)
- Roberto Teggi
- ENT Division, San Raffaele Scientific Institute, Vita e Salute University, Milano, Italy
| | - Bruno Colombo
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Familiari
- ENT Division, San Raffaele Scientific Institute, Vita e Salute University, Milano, Italy
| | - Iacopo Cangiano
- ENT Division, San Raffaele Scientific Institute, Vita e Salute University, Milano, Italy
| | - Mario Bussi
- ENT Division, San Raffaele Scientific Institute, Vita e Salute University, Milano, Italy
| | - Massimo Filippi
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- “Vita-Salute” University, San Raffaele, Milan, Italy
| |
Collapse
|
2
|
Prasetio AD, Irsalina P, Islamiyah WR, Ardiansyah D. Neuro-otology symptoms as the early sign in pediatric patient with a pineal gland tumor: a case report. Radiol Case Rep 2022; 17:3051-3054. [PMID: 35789558 PMCID: PMC9249574 DOI: 10.1016/j.radcr.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
Patients with pineal tumors are often asymptomatic and the symptoms depend on the location of the mass. In fact, around 3%-8% of pediatric brain tumor cases are pineal tumors. Children with pineal tumors may present with dizziness and vertigo as early signs. These symptoms are common conditions among 5-15 years old children and could probably lead to misdiagnoses. We present a case of 14-year-old who came to the emergency room of DR. Soetomo Hospital Surabaya with neurotologic symptoms. After a series of radiographic and laboratory examinations, he was diagnosed with germinoma. A ventriculoperitoneal shunt was performed in the emergency room and intravenous dexamethasone was administered.
Collapse
|
3
|
Božanić Urbančič N, Vozel D, Kordiš Š, Hribar M, Urbančič J, Battelino S. Indicators of pediatric peripheral vestibular disorder: A retrospective study in a tertiary referral center. Int J Pediatr Otorhinolaryngol 2022; 159:111221. [PMID: 35785585 DOI: 10.1016/j.ijporl.2022.111221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/19/2021] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aims to present characteristics of pediatric patients with peripheral vertigo and dizziness and their clinical workup results in the tertiary otorhinolaryngology center. We wanted to investigate whether the detailed history could replace the extensive vestibular testing and whether the clinical presentation could guide the first contact physician to appropriately directed specialist referral. METHODS Retrospective case review of consecutive pediatric vertigo and dizziness patients referred to the tertiary otorhinolaryngology center from 2015 to 2020. The data about the signs and symptoms of vertigo and dizziness and the results of audiological and vestibular tests were collected. RESULTS Of 257 children aged 10.9±4.3 years (R: 1-17 years), 32 (12.5%) had peripheral, and 49 (19%) had central vertigo and dizziness. Acute vestibulopathy was diagnosed in 22/257 (8.5%) children, sudden sensorineural hearing loss and benign paroxysmal positional vertigo in 5/257 (2%) children each. 60% of children with peripheral vertigo and dizziness had emesis, and 55.6% had nausea. 8% of children had spontaneous horizontal-rotatory nystagmus that followed Alexander's law. Goodman and Kruskal's л for determining whether the type of nystagmus could predict the type of vertigo and dizziness (central or peripheral) was 0.481 (p = 0.001). 12/26 (60%) of children with peripheral vertigo and dizziness had emesis compared to 14 (30.04%) children without emesis, a difference in proportions of 0.296 (p = 0.024, chi-square test of homogeneity). Binomial logistic regression to ascertain the effects of duration, nausea and emesis on the likelihood of the presence of peripheral vertigo was statistically significant (χ2(3) = 10.626, p = 0.014). CONCLUSION Unlike adults, peripheral vestibular causes of vertigo and dizziness in children may be rare but have the same typical signs and symptoms. The detailed history and careful clinical examination are crucial in differentiating between peripheral and central causes. This guides the first contact physician for further referral to appropriate specialists included in a multidisciplinary workup. Namely, nausea, emesis, horizontal nystagmus and a longer duration of symptoms in a child with vertigo and dizziness indicate a peripheral etiology. Therefore, a referral to an otorhinolaryngologist is reasonable.
Collapse
Affiliation(s)
- Nina Božanić Urbančič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000, Ljubljana, Slovenia.
| | - Domen Vozel
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000, Ljubljana, Slovenia.
| | - Špela Kordiš
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia.
| | - Manja Hribar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000, Ljubljana, Slovenia.
| | - Jure Urbančič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000, Ljubljana, Slovenia.
| | - Saba Battelino
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000, Ljubljana, Slovenia.
| |
Collapse
|
4
|
Pellegrino N, Di Stefano V, Rotondo E, Graziosi A, Rispoli MG, Torrente A, Lupica A, Brighina F, Raucci U, Parisi P. Neurological vertigo in the emergency room in pediatric and adult age: systematic literature review and proposal for a diagnostic algorithm. Ital J Pediatr 2022; 48:125. [PMID: 35897016 PMCID: PMC9327316 DOI: 10.1186/s13052-022-01313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
Neurological vertigo is a common symptom in children and adults presenting to the emergency department (ED) and its evaluation may be challenging, requiring often the intervention of different medical specialties. When vertigo is associated with other specific symptoms or signs, a differential diagnosis may be easier. Conversely, if the patient exhibits isolated vertigo, the diagnostic approach becomes complex and only through a detailed history, a complete physical examination and specific tests the clinician can reach the correct diagnosis. Approach to vertigo in ED is considerably different in children and adults due to the differences in incidence and prevalence of the various causes. The aim of this systematic review is to describe the etiopathologies of neurological vertigo in childhood and adulthood, highlighting the characteristics and the investigations that may lead clinicians to a proper diagnosis. Finally, this review aims to develop an algorithm that could represent a valid diagnostic support for emergency physicians in approaching patients with isolated vertigo, both in pediatric and adult age.
Collapse
Affiliation(s)
- Noemi Pellegrino
- Neonatal Intensive Care Unit, Pescara Public Hospital, Pescara, Italy
| | - Vincenzo Di Stefano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Eleonora Rotondo
- Department of Pediatric and Neonatology, Ciriè Hospital, Ciriè, Piemonte, Italy
| | | | | | - Angelo Torrente
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Antonino Lupica
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine & Psychology, "Sapienza" University, Sant'Andrea Hospital, Rome, Italy.
| |
Collapse
|
5
|
Kim JS. Benign paroxysmal vertigo of childhood. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.2.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Benign paroxysmal vertigo (BPV), one of the most common causes of pediatric vertigo, is characterized by recurrent sudden short-lived attacks of vertigo, which resolve spontaneously without residual disability in otherwise healthy children. In this report, we present a literature review on BPV in childhood.Current Concepts: A child with BPV appears frightened and experiences a spinning sensation with occasional nystagmus and vomiting. Episodes usually last less than a minute and are not associated with hearing loss and altered consciousness. Most patients present with a relapsing-remitting clinical course for weeks to years, after which they usually resolve spontaneously. Based on current evidence, BPV of childhood is considered a variant of migraine, and vasospasm observed in patients with migraine plays an important role in the pathogenesis of this disorder. It is important to differentiate BPV from other diseases that present with vertigo, including basilar migraine, closed head injury, psychiatric dizziness, and acute labyrinthitis.Discussion and Conclusion: BPV is a common but important disorder observed in children and should be considered in the differential diagnosis in children with the aforementioned clinical presentation. It is important to reassure patients and parents regarding the benign course of BPV.
Collapse
|
6
|
Clark JE, Pate R, Rine RM, Christy J, Dalton P, Damiano DL, Daniels S, Holmes JM, Katzmarzyk PT, Magasi S, McCreery R, McIver K, Newell KM, Sanger T, Sugden D, Taveras E, Hirschfeld S. NCS Assessments of the Motor, Sensory, and Physical Health Domains. Front Pediatr 2021; 9:622542. [PMID: 34900852 PMCID: PMC8661476 DOI: 10.3389/fped.2021.622542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/03/2021] [Indexed: 11/17/2022] Open
Abstract
As part of the National Children's Study (NCS) comprehensive and longitudinal assessment of the health status of the whole child, scientific teams were convened to recommend assessment measures for the NCS. This manuscript documents the work of three scientific teams who focused on the motor, sensory, or the physical health aspects of this assessment. Each domain team offered a value proposition for the importance of their domain to the health outcomes of the developing infant and child. Constructs within each domain were identified and measures of these constructs proposed. Where available extant assessments were identified. Those constructs that were in need of revised or new assessment instruments were identified and described. Recommendations also were made for the age when the assessments should take place.
Collapse
Affiliation(s)
- Jane E. Clark
- Department of Kinesiology, School of Public Health, University of Maryland, College Park, MD, United States
| | - Russell Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | | | - Jennifer Christy
- Department of Physical Therapy, University of Alabama, Birmingham, AL, United States
| | - Pamela Dalton
- Monell Chemical Senses Center, Monell Center, Philadelphia, PA, United States
| | - Diane L. Damiano
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, United States
| | - Stephen Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, United States
| | - Jonathan M. Holmes
- Department of Ophthalmology and Vision Science, University Arizona, Tucson, AZ, United States
| | - Peter T. Katzmarzyk
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Susan Magasi
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Ryan McCreery
- Boys Town National Research Hospital, Boys Town, NE, United States
| | - Kerry McIver
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Karl M. Newell
- Department of Kinesiology, University of Georgia, Athens, GA, United States
| | - Terence Sanger
- Department of Biomedical Engineering, Neurology, and Biokinesiology, University of Southern California, Los Angeles, CA, United States
| | - David Sugden
- School of Education, University of Leeds, Leeds, United Kingdom
| | - Elsie Taveras
- Department of Pediatrics, Harvard Medical School and Mass General Hospital for Children, Boston, MA, United States
| | | |
Collapse
|
7
|
Unraveling the Etiology of Pediatric Vertigo and Dizziness: A Tertiary Pediatric Center Experience. ACTA ACUST UNITED AC 2021; 57:medicina57050475. [PMID: 34064850 PMCID: PMC8151727 DOI: 10.3390/medicina57050475] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Numerous authors have reported that the commonest type of vertigo in children is migraine-associated vertigo (vestibular migraine and benign paroxysmal vertigo of childhood—BPV). We aimed to provide the possible etiological background of vertigo and dizziness in Slovenian children. Materials and Methods: A retrospective case series of pediatric vertigo and dizziness children referred to the tertiary pediatric otorhinolaryngology center from 2015 to 2020. Children received a complete audiological and vestibular workup and were referred to pediatric specialists depending on the clinical presentation. Results: Of 257 children (42% male, 58% female) aged 1–17 years (M = 10.9, SD = 4.3 years) in 19.1% vertigo and dizziness were classified as central, in 12.4% as a peripheral vestibular, in 10.9% as a hemodynamic, in 5.8% as a psychological and none as visual by pediatric neurologists, otorhinolaryngologists, cardiologists, psychologists or ophthalmologists, respectively. 40.8% (20) children with central vertigo had BPV (7.8% of all children) and 8.2% (4) migrainous vertigo. In 43.6% (112 children), the etiology remained unclassified. Conclusions: After a thorough multidisciplinary workup, the etiology of vertigo and dizziness was unraveled in the majority of children referred to our tertiary otorhinolaryngology center. The most common cause was central; however, in a considerable number, the etiology remained unclassified. The latter could be attributed to the self-limiting nature of vertigo spells. Hence, a child presenting with dizziness and vertigo requires a multidisciplinary approach, in which referral to a neurologist is, in most cases, essential.
Collapse
|
8
|
Perez-Carpena P, Lopez-Escamez JA. Do we need to reconsider the classification of vestibular migraine? Expert Rev Neurother 2021; 21:503-516. [PMID: 33755502 DOI: 10.1080/14737175.2021.1908129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: Vestibular migraine (VM) is a complex disease characterized by recurrent episodes of migraine associated with vertigo attacks that are observed in 1-3% of the general population. Given its high prevalence and the impact on the health system, it is important to characterize these patients, in order to offer an accurate diagnosis and a proper treatment. As the diagnosis of VM is based on clinical features, the study of potential biomarkers has gained more interest in the last years, to improve the precision in the diagnosis of this disease. The aim of this review is to summarize the main tests available for the diagnosis of VM, including the accuracy of biomarkers for the diagnosis of VM.Areas covered: This review summarizes the main information on VM, including all diagnosis records published in the field in the last 10 years, and focusing on candidate biomarkers for the diagnosis of VM patients.Expert opinion: There is a limited knowledge in the pathophysiology of VM. The search of biomarkers for diagnosis of VM is needed to improve the precision in the diagnosis promoting clinical and translational research. The potential reclassification of VM will depend upon the discovery and validation of these biomarkers.
Collapse
Affiliation(s)
- Patricia Perez-Carpena
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO-Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta De Andalucía, Granada, PTS, Spain.,Department of Otolaryngology, Instituto De Investigación Biosanitaria ibs.GRANADA, Hospital Universitario Virgen De Las Nieves, Granada, Spain
| | - Jose A Lopez-Escamez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO-Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta De Andalucía, Granada, PTS, Spain.,Department of Otolaryngology, Instituto De Investigación Biosanitaria ibs.GRANADA, Hospital Universitario Virgen De Las Nieves, Granada, Spain.,Department of Surgery, Division of Otolaryngology, Universidad De Granada, Granada, Spain
| |
Collapse
|
9
|
Dasgupta S, Mandala M, Salerni L, Crunkhorn R, Ratnayake S. Dizziness and Balance Problems in Children. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-0615-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
10
|
Bolbecker AR, Apthorp D, Martin AS, Tahayori B, Moravec L, Gomez KL, O’Donnell BF, Newman SD, Hetrick WP. Disturbances of postural sway components in cannabis users. Drug Alcohol Depend 2018; 190:54-61. [PMID: 29983392 PMCID: PMC7185833 DOI: 10.1016/j.drugalcdep.2018.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A prominent effect of acute cannabis use is impaired motor coordination and driving performance. However, few studies have evaluated balance in chronic cannabis users, even though density of the CB1 receptor, which mediates the psychoactive effects of cannabis, is extremely high in brain regions critically involved in this fundamental behavior. The present study measured postural sway in regular cannabis users and used rambling and trembling analysis to quantify the integrity of central and peripheral nervous system contributions to the sway signal. METHODS Postural sway was measured in 42 regular cannabis users (CB group) and 36 non-cannabis users (N-CB group) by asking participants to stand as still as possible on a force platform in the presence and absence of motor and sensory challenges. Center of pressure (COP) path length was measured, and the COP signal was decomposed into rambling and trembling components. Exploratory correlational analyses were conducted between sway variables, cannabis use history, and neurocognitive function. RESULTS The CB group had significantly increased path length and increased trembling in the anterior-posterior (AP) direction. Exploratory correlational analyses suggested that AP rambling was significantly inversely associated with visuo-motor processing speed. DISCUSSION Regular cannabis use is associated with increased postural sway, and this appears to be predominantly due to the trembling component, which is believed to reflect the peripheral nervous system's contribution to the sway signal.
Collapse
Affiliation(s)
- Amanda R. Bolbecker
- Dept. of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States,Dept. of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States,Larue D. Carter Memorial Hospital, Indianapolis, IN, United States,School of Psychology and Behavioural Science, University of New England, NSW, Australia,Corresponding author at: Dept. of Psychological and Brain Sciences, Indiana University, 1101 E. Tenth St., Bloomington, IN, 47405, United States. (A.R. Bolbecker)
| | - Deborah Apthorp
- School of Psychology and Behavioural Science, University of New England, NSW, Australia,Research School of Computer Science, Australian National University, ACT, Australia
| | | | - Behdad Tahayori
- Department of Biomedical Engineering, Florida International University, Miami, Florida, United States
| | - Leah Moravec
- Dept. of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Karen L. Gomez
- Dept. of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Brian F. O’Donnell
- Dept. of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States,Dept. of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States,Larue D. Carter Memorial Hospital, Indianapolis, IN, United States
| | - Sharlene D. Newman
- Dept. of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - William P. Hetrick
- Dept. of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States,Dept. of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States,Larue D. Carter Memorial Hospital, Indianapolis, IN, United States
| |
Collapse
|
11
|
Kim SH. Dizziness and orthostatic intolerance in pediatric migraine. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.2.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Seung Hyo Kim
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| |
Collapse
|
12
|
Murofushi T, Komiyama S, Suizu R, Yoshimura E. Otolithic vertigo in children: Report of 3 cases. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2016. [DOI: 10.1080/23772484.2016.1235466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
|
13
|
Sommerfleck PA, González Macchi ME, Weinschelbaum R, De Bagge MD, Bernáldez P, Carmona S. Balance disorders in childhood: Main etiologies according to age. Usefulness of the video head impulse test. Int J Pediatr Otorhinolaryngol 2016; 87:148-53. [PMID: 27368464 DOI: 10.1016/j.ijporl.2016.06.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 01/03/2023]
Abstract
UNLABELLED Balance disorders are common in adult patients but less usual in the pediatric population. When this symptomatology appears in children it is a cause for concern, both for parents and health-care professionals. OBJECTIVES To explain the balance disorders in children describing a case series and to discuss the main etiologies found according to age. STUDY DESIGN A retrospective, observational, descriptive, and cross-sectional study was conducted. POPULATION Patients aged 1-18 years who consulted because of balance disorders at the otolaryngology department of a pediatric tertiary-care hospital between March 2012 and July 2015. RESULTS Two hundred and six patients were included in the study. Median age was 10 years. The most common diagnoses were vestibular migraine in 21.8% of the children, ataxia in 9.22%, benign paroxysmal vertigo of childhood in 7.77%, and post-traumatic vertigo in 6.31%.Overall, 61 videonystagmographies- of which 46 were normal - and 55 video head impulse tests - which were normal in 45 and showed abnormalities in the vestibulo-ocular reflex gain in 10 - were performed. CONCLUSIONS In a child with balance disorders, the medical history and neurotological examination are essential. Vestibular migraine is the most commonly found disorder in every age group, and most of the patients have a family history of migraine. Ancillary studies, especially the video head-impulse test, provide important data to confirm the diagnosis.
Collapse
Affiliation(s)
| | | | - Romina Weinschelbaum
- Neuro-otology Department, INEBA Instituto de Neurociencias de Buenos Aires, Argentina.
| | | | - Patricia Bernáldez
- Otorhinolaryngology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Argentina.
| | - Sergio Carmona
- Neuro-otology Department, INEBA Instituto de Neurociencias de Buenos Aires, Argentina.
| |
Collapse
|
14
|
Abstract
Vertigo and dizziness of at least moderate severity occur in >5% of school-aged children and cause considerable restrictions in participation in school and leisure activity. More than 50% of dizzy children also have headache. Vestibular migraine and benign paroxysmal vertigo as a migraine precursor are the most common diagnoses in dizziness clinics for children and adolescents. They account for 30-60% of diagnoses. Other common causes are somatoform, orthostatic, or posttraumatic dizziness. All other disorders that are known to cause vertigo and dizziness in adults also occur in children, but incidence rates are usually lower. The vestibular and balance systems are largely developed after 1 year of age. Therefore, clinical and laboratory testing is reliable. Brain magnetic resonance imaging to exclude severe conditions, such as a brainstem tumor, is necessary only if clinical - in particular, ocular motor - testing is abnormal. Most conditions causing vertigo and dizziness in childhood and adolescence are treatable. Nonpharmacologic prophylaxis should always be recommended in vestibular migraine. Behavioral support is useful in somatization. Evidence for the effectiveness of drug therapy is largely based on experience in adult populations. High-quality controlled studies in childhood cohorts are sparse. It is important to make a correct diagnosis early on, as counseling and appropriate treatment may avoid chronic illness.
Collapse
Affiliation(s)
- K Jahn
- Schön Klinik Bad Aibling and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Munich, Germany.
| |
Collapse
|
15
|
Raucci U, Vanacore N, Paolino MC, Silenzi R, Mariani R, Urbano A, Reale A, Villa MP, Parisi P. Vertigo/dizziness in pediatric emergency department: Five years’ experience. Cephalalgia 2015; 36:593-8. [DOI: 10.1177/0333102415606078] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/10/2015] [Indexed: 01/03/2023]
Abstract
Background Vertigo/Dizziness in childhood is not a rare cause of visits to the emergency department (ED). We analyzed a selected group with vertigo/dizziness to identify signs and symptoms that may help to guide the diagnostic approach and management. Methods A total of 616 children admitted for vertigo to the ED over a five-year period were retrospectively reviewed. Their medical history, clinical characteristics, laboratory and neuroimaging tests, final diagnoses and management were analyzed. Results Migraine and syncope were the most frequent causes. Two patients were affected by life-threatening cardiac syncope, while structural life-threatening central nervous system diseases were found in 15 patients, none of whom presented with vertigo as an isolated clinical finding. Conclusions Most cases of vertigo/dizziness in childhood that consist mainly of migraine and syncope are of benign origin. The prompt identification of neurological or cardiological signs or symptoms associated with vertigo in children is mandatory to rule out life-threatening conditions.
Collapse
Affiliation(s)
- Umberto Raucci
- Emergency Pediatric Department, Bambino Gesù Children’s Hospital, IRCCS, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance, and Health Promotion, National Institute of Health, Italy
| | - Maria Chiara Paolino
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Italy
| | - Romina Silenzi
- Department of Pediatrics (DPUO), University of Rome Tor Vergata, Bambino Gesù Children's Hospital, IRCCS, Italy
| | - Rosanna Mariani
- Emergency Pediatric Department, Bambino Gesù Children’s Hospital, IRCCS, Italy
| | - Antonella Urbano
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Italy
| | - Antonino Reale
- Emergency Pediatric Department, Bambino Gesù Children’s Hospital, IRCCS, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Italy
| |
Collapse
|
16
|
A loss-of-function CACNA1A mutation causing benign paroxysmal torticollis of infancy. Eur J Paediatr Neurol 2014; 18:430-3. [PMID: 24445160 DOI: 10.1016/j.ejpn.2013.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 11/25/2013] [Accepted: 12/23/2013] [Indexed: 11/24/2022]
Abstract
Benign paroxysmal torticollis of infancy (BPTI) is a rare paroxysmal disorder characterized by recurrent episodes of head tilt and accompanying general symptoms which remit spontaneously. The rare association with gain-of-function CACNA1A mutations, similar to hemiplegic migraine, has been reported. We report here two new BPTI patients from the same family carrying a heterozygous mutation in the CACNA1A gene leading to the change p.Glu533Lys. Functional analysis revealed that this mutation induces a loss of channel function due to impaired gating by voltage and much lower current density. Our data suggest that BPTI, a periodic syndrome commonly considered a migraine precursor, constitutes an age-specific manifestation of defective neuronal calcium channel activity.
Collapse
|
17
|
|