Unraveling the Etiology of Pediatric Vertigo and Dizziness: A Tertiary Pediatric Center Experience

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.

MIGRAINOUS VERTIGO. An APPROACH

Background: Migraine and vertigo are highly prevalent; their simultaneous presentation is frequent and may require a different diagnostic approach than that used for migraine and vertigo separately. Migraine vertigo is recognized as a defined entity within the IHS classification of headaches. Methods: We reviewed the principal manifestations of peripheral and central affection (brainstem) that explain this clinical picture presentation, reviewed the general characteristics, epidemiology, semiology, treatment and prognosis. Results: The symptomatology suggest that the pathophysiology occurs as a vascular problem with aseptic inflammation and also affects the posterior territory. Although the condition's evolution is usually favorable, its dramatic presentation requires a detailed diagnostic approach (clinical and image), although the treatment does not differ from migraine's general management. Conclusion: The vestibular migraine or Migrainous Vertigo is an already defined entity, although the treatment is similar to the migraine with and without aura.

Anxiety and depression associated with vertigo: a cross sectional study from India

<p class="abstract"><strong>Background:</strong> Vertigo is a common clinical symptom in the community as well as in specialist settings. Depression and anxiety are common among vertigo patients and have a significant impact on the course of illness.</p><p class="abstract"><strong>Methods:</strong> This study was conducted at the outpatient clinics of Department of ENT, Government Medical College, Kottayam. Zung self-rating anxiety and Zung self-rating depression scales were used. </p><p class="abstract"><strong>Results:</strong> There were 158 patients in the study. The commonest diagnosis was benign paroxysmal positional vertigo (BPPV) (76; 48.1%) followed by migrainous vertigo (MV) (41; 25.9%), Meniere’s disease (MD) (31; 19.6%) and vestibular neuronitis (VN) (10; 6.3%). 74 (46.83%) patients had depression. Depression was most prevalent among MD (26; 83.87%) followed by MV (29; 70.73%). Mean depression score was highest with MD (58; SD=8.136) followed by MV (54.29; SD=10.441). 70 (44.03%) patients had anxiety. 50 being women and 20 men. A diagnosis of anxiety was most common in MD (25; 80.6%) followed by MV (33; 80.5%). Mean anxiety score was highest in MD (56.48; SD=11.003) followed by MV (54.15; SD=12.041), A diagnosis of anxiety was most common among patients with MD (25; 80.6%) followed by MV (33; 80.5%).</p><p class="abstract"><strong>Conclusions:</strong> There is a high prevalence of depression and anxiety in Meniere’s disease and migrainous vertigo in India as evidenced by this study. Identification and appropriate management of coexisting mental health problems to address the disability, poor quality of life and protracted course is an integral part of managing vertigo.</p><p class="abstract"> </p>

Migraine and benign paroxysmal positional vertigo: a single-institution review

Background:Benign paroxysmal positional vertigo and migraine-associated dizziness are common. The prevalence of benign paroxysmal positional vertigo seems to be higher in patients with migraine-associated dizziness than in those without migraine.Methods:A database of 508 patients seen at the primary author's balance clinic was analysed to determine the prevalence of migraine, as defined by International Headache Society criteria, in patients with benign paroxysmal positional vertigo.Results:The percentage of patients with dizziness or vertigo who met criteria for migraine was 33.7 per cent, with a prevalence of benign paroxysmal positional vertigo of 42.3 per cent. When excluding patients with migrainous vertigo, patients with migraine frequently had benign paroxysmal positional vertigo (66.7 per centvs55.8 per cent), although this finding was not statistically significant.Conclusion:The results for the entire sample suggest that, after excluding patients with migrainous vertigo, patients with migraine seem more likely to have benign paroxysmal positional vertigo; however, this association was not significant, probably because of the small sample size.

Tetra-ataxiometric Posturography in Patients with Migrainous Vertigo

Background: Migraine is a common disorder characterized by headache attacks frequently accompanied by vestibular symptoms like dizziness, vertigo, and balance disorders. Clinical studies support a strong link between migraine and vertigo rather than between other headache types and vertigo or nonvertiginous dizziness. There is a lack of consensus regarding the pathophysiology of migrainous vertigo. Activation of central vestibular processing during migraine attacks and vasospasm-induced ischemia of the labyrinth are reported as the probable responsible mechanisms. Because vestibular examination alone does not provide enough information for diagnosis of migrainous vertigo, posturography systems which provide objective assessment of somatosensory, vestibular, and visual information would be very helpful to show concomitant involvement of the vestibular and somato-sensorial systems. There are few posturographic studies on patients with migraine but it seems that how balance is affected in patients with migraine and/or migrainous vertigo is still not clear. We want to investigate balance function in migraineurs with and without vertigo with a tetra-ataxiometric posturography system and our study is the first study in which tetra-ataxiometric static posturography was used to evaluate postural abnormalities in a well-defined population of patients with migrainous vertigo. Objective: To investigate balance functions in migraineurs with and without vertigo with a tetra-ataxiometric posturography system. Study Design: Prospective, nonrandomized, controlled study. Setting: Pamukkale University Hospital, Neurology and Physical Therapy and Rehabilitation outpatient clinics. Methods: Sixteen patients with migrainous vertigo, 16 patients with migraine without aura and no vestibular symptoms, and 16 controls were included in the study. Computerized static posturography system was performed and statistical analyses of fall, Fourier, Stability, and Weight distribution indexes were performed. The tetra-ataxiometric posturography device measures vertical pressure fluctuations on 4 independent stable platforms, each placed beneath 2 heels and toe parts of the patient; inputs from these platforms are integrated and processed by a computer digitally. Four separate plates are used and perpendicular pressures of the anterior and posterior feet are measured. Pressure of each force plate is measured and data was analyzed by the software program. Limitations: A very small, non-randomized, and controlled study with the inability to find an answer to the mechanism of involvement of the somatosensorial system and vestibular system in migrainous headaches. Results: The distribution of patients with posturographical abnormalities in the migrainous vertigo group was significantly different than the control group. Distribution of the patients with posturographical abnormalities in the high frequencies of the head-right position was significantly different in the migrainous vertigo group than in the control group and distribution of the patients with posturographical abnormalities in high frequencies of the head-right position was significantly different in the migraine group than in the controls groups. The stability index of the migrainous vertigo group was significantly higher than in the control group when tested on in the neutral-head position with open eyes. Conclusion: In this first study of tetra-ataxiometric static posturography evaluating postural abnormalities in a well-defined population of patients with migrainous vertigo, the central part of the vestibular apparatus would be responsible of postural abnormalities in patients with migraine and migrainous vertigo. Key words: Fall index, migraine, migrainous vertigo, static posturography