Constantino Morera Pérez

Aportación del potencial vestibular miogénico evocado al estudio de la neuritis vestibular

Resumen Introduccion y objetivos Hasta epoca reciente solo disponiamos del test calorico y del test cinetico como pruebas fundamentales para el conocimiento de la funcion vestibular, los cuales solo aportan informacion sobre el canal semicircular externo y el nervio vestibular superior. En los ultimos anos, ha comenzado a desarrollarse el estudio del potencial vestibular miogenico evocado, que permite valorar el saculo y el nervio vestibular inferior. Nuestro objetivo es, a partir del estudio de los resultados del test calorico y del potencial vestibular miogenico evocado en pacientes con neuritis vestibular, diferenciar si la afectacion es del nervio vestibular superior, inferior o de ambos. Material y metodos Estudio retrospectivo de 9 pacientes ingresados en un hospital terciario, con diagnostico de neuritis vestibular. Les practicamos estudio con anamnesis, exploracion clinica otoneurologica, test calorico y potencial vestibular miogenico evocado. Tambien se estudio la evolucion clinica despues del ingreso y la inestabilidad residual. Resultados Hubo una afectacion mayor de mujeres (66,6 %). La edad media ± desviacion estandar de presentacion de la enfermedad fue de 53,8 ± 14 anos. El tiempo de estancia hospitalaria ha sido de 5,7 ± 3,2 dias. Despues de la crisis, presentaron inestabilidad durante 122 ± 114 dias. Se diagnosticaron 4 casos de neuritis vestibular completa y 5 de neuritis vestibular superior. La latencia de la onda p13 fue normal en todos los casos. No hay diferencias en el tiempo de estancia hospitalaria, ni en la inestabilidad residual entre los grupos. Conclusiones Actualmente, con el potencial vestibular miogenico evocado, es posible profundizar en el estudio de la neuritis vestibular. Es mucho mas frecuente la neuritis vestibular completa y la neuritis vestibular superior que la neuritis vestibular inferior. El comportamiento clinico es similar en los subtipos encontrados.

Expresión clínica de las alteraciones del equilibrio en pacientes con síndrome de latigazo cervical

Introduccion y objetivo: Entre las enfermedades que pueden producir trastornos del equilibrio, el sindrome de latigazo cervical (LC) adquiere cada vez mayor relevancia, al aumentar su frecuencia por los accidentes de trafico. Hay varias hipotesis en cuanto a la generacion de mareos y vertigos en relacion con el LC. El objetivo de este estudio es describir y analizar la sintomatologia clinica que refieren estos pacientes. Material y metodo: Estudio prospectivo de 36 pacientes, con LC por accidente de trafico, que fueron remitidos a la unidad de otoneurologia por afeccion relacionada con el equilibrio. Ningun paciente habia sufrido traumatismo craneoencefalico ni afeccion vestibular previamente al accidente. Se practico anamnesis exhaustiva, videonistagmografia y resonancia magnetica cervical. Se clasificaron los casos de acuerdo con el tipo de sintomatologia del equilibrio y el grado de lesion cervical. Resultados: El 55,5 % de los pacientes presentaron sensacion de mareo fugaz, en su mayoria en relacion con cambios posturales y movimientos cefalicos. Un 38,8 % presento sensacion de inestabilidad continua; 6 (16,7 %) casos tuvieron vertigo, 3 de ellos compatible con vertigo posicional paroxistico benigno, 2 con conmocion laberintica y un caso no pudo filiarse a ningun diagnostico. Conclusiones: En el sindrome de LC el sintoma mas frecuente, en relacion con el equilibrio, es la sensacion de mareo fugaz asociado a movimientos cefalicos; solo un pequeno grupo padece vertigo. Aunque las pruebas vestibulares son normales en la mayoria de los pacientes, no podemos descartar que haya una lesion otolitica.

Meningitis de repetición asociada a síndrome de Duane tipo 1

We present the case of a 17-month-old male patient with a bilateral Duane syndrome type 1 associated to unilateral cochleovestibular dysplasia, perilymphatic fistula and recurrent meningitis. Diagnosis was carried out by MRI and CT scan. His management and treatment are described, as well as the postoperative evolution. We believe this is an exceptional case due to the low frequency of this syndrome, as well as to the otoneurological complications.

Clinical symptoms of equilibrium disorders in patients with whiplash syndrome

INTRODUCTION AND OBJECTIVE There are many entities that cause equilibrium disorders. Whiplash syndrome is becoming an important entity as a trigger of equilibrium disorders because of an increase in traffic accidents. There are many hypotheses on the generation of vertigo and dizziness in whiplash syndrome. The objective of this study is to describe and analyze the clinical symptoms of patients who suffered whiplash. MATERIAL AND METHOD Thirty six patients with equilibrium disorders who suffered whiplash syndrome were studied prospectively. None of these subjects had cranial trauma or a history of vestibular pathology prior to the traffic accident. We conducted an exhaustive anamnesis, videonystagmography and cervical magnetic resonance. Patients were classified by type of equilibrium symptom and degree of cervical lesion. RESULTS 55.5 % of patients had a sensation of dizziness associated with postural and cephalic movements, 38.8 % had disequilibrium continuously, and 16.7 % (6 cases) had vertigo. Three of this last group had a diagnosis compatible with benign positional vertigo but this diagnosis was confirmed in only 2 patients; two patients had labyrinth commotion and one patient had vertigo of unknown origin. CONCLUSIONS In patients with whiplash, the most frequent equilibrium symptom is the sensation of fleeting dizziness associated with head movements, while only a small group suffer from vertigo. Although vestibular tests are normal in most patients, we cannot rule out the existence of otolithic lesions.

Contribution of the vestibular evoked myogenic potentials to the study of the vestibular neuritis

INTRODUCTION Until recently, the only tests available to provide information about vestibular function were caloric and kinetic tests, which only give us information about the external semicircular canal and the superior vestibular nerve. In recent years the development of vestibular evoked myogenic potentials has allowed us to assess the saccule and the inferior vestibular nerve. Our aim is, by studying the caloric test results as well as the vestibular evoked myogenic potentials in patients with Vestibular Neuritis, to determine whether they have involvement of the superior, inferior or both vestibular nerves. MATERIAL AND METHODS Retrospective study of 9 patients with Vestibular Neuritis admitted to a tertiary care hospital. We studied them by means of anamnesis, otoneurological clinical examination, caloric test and vestibular evoked myogenic potentials. Their clinical progress after admission and any residual instability were also studied. RESULTS Women were more affected (66.6 %) than males. The mean age for presentation of the disease was 53.8 +/- 14.0 years. Hospital stays lasted for 5.7 +/- 3.2 days. After their crises, they suffered from instability for 122 +/- 114 days. Four cases were diagnosed as Complete Vestibular Neuritis and five as Superior Vestibular Neuritis. P13 wave latency was normal in all cases. There were no differences between the groups in terms of the length of hospital stay nor residual instability. CONCLUSIONS Nowadays, vestibular evoked myogenic potentials make it possible to advance further in the study of Vestibular Neuritis. Complete and superior vestibular neuritis are much more frequent than inferior vestibular neuritis. Clinical behaviour is similar in the sub-types found.

One-Year Results for Patients with Unilateral Hearing Loss and Accompanying Severe Tinnitus and Hyperacusis Treated with a Cochlear Implant

Objective: To show that patients with unilateral hearing loss (UHL), with one ear fulfilling cochlear implant (CI) indication criteria, and an additional severe tinnitus handicap can be treated effectively with a CI. Method: A prospective multi-centre study was conducted in five Spanish centres. Sixteen adult patients with UHL and a mean Tinnitus Handicap Inventory (THI) score of at least 58 were implanted. The study design included repeated within-subject measures of quality of life (Health Utility Index Mark 3 [HUI3]), tinnitus (THI, Visual Analogue Scale [VAS] on tinnitus loudness), hearing (Speech, Spatial, and Qualities of Hearing Scale– [SSQ]), and hyperacusis (Test de Hipersensibilidad al Sonido [THS]) up to 12 months after the initial CI fitting. Results: Group data showed significant subjective benefit from CI treatment: the preoperative HUI3 total utility score of 0.45 went up to 0.57 at 6 months and 0.63 at 12 months; the preoperative THI total score of 75 decreased to 40 at 6 months and 35 at 12 months. The preoperative tinnitus loudness VAS score of 8.2 decreased to 2.4 at 6 months and 2.2 at 12 months with the implant “On” and to 6.7 at 6 months and 6.5 at 12 months with the implant “Off.” The preoperative THS total score of 26 decreased to 17 at 12 months. The preoperative SSQ total score of 4.2 increased to 5.1 at 6 months and 6.3 at 12 months. No unanticipated adverse events were reported during the study period. At 12 months after CI activation all subjects (except 1 subject who used the device 6 days a week) wore their devices all day and every day. The primary reason for CI use was split evenly between tinnitus suppression (n = 6) and both hearing and tinnitus (n = 6). Conclusion: A CI should be considered as a treatment option in patients with UHL and a concomitant severe tinnitus handicap. However, appropriate counselling of candidates on the anticipated risks, benefits, and limitations that are inherent to cochlear implantation is imperative.