Mareos espontáneos episódicos

Abstract

Purpose of review

Conditions causing recurrent spontaneous episodes of dizziness or vertigo span several medical specialties, making it challenging for clinicians to gain confidence in evaluating and managing the spectrum of episodic vestibular disorders. Patients are often asymptomatic and have normal examinations at the time of evaluation. Thus, diagnosis depends heavily on eliciting key features from the history. Overreliance on symptom quality descriptions commonly leads to misdiagnosis. The goal of this article is to provide the reader with a straightforward approach to the diagnosis and management of conditions that cause episodic spontaneous dizziness.

 

Recent findings

Consensus diagnostic criteria have been established for vestibular migraine, Ménière disease, vestibular paroxysmia, and hemodynamic orthostatic dizziness/vertigo. Vertigo has been recognized as a common symptom in vertebrobasilar ischemia, cardiogenic dizziness, and orthostatic hypotension. Treatment recommendations for vestibular migraine still lack high-quality evidence, but controlled trials are occurring.

 

Summary

The evaluation should start with a detailed description of the episodes from the patient and any observers. Rather than focusing first on whether the symptom quality is most consistent with vertigo, dizziness, lightheadedness, or unsteadiness, the clinician should clarify the timing (episode frequency and duration), possible triggers or circumstances (eg, position changes, upright posture), and accompanying symptoms. History should identify any auditory symptoms, migraine features, posterior circulation ischemic symptoms, vascular risk factors, clues for anxiety, and potentially relevant medications. Carefully selected testing can help secure the diagnosis, but excessive and indiscriminate testing can lead to more confusion. Treatments for these conditions are vastly different, so an chúrate diagnosis is critical.

 

Eggers SDZ. Episodic Spontaneous Dizziness. Continuum (Minneap Minn). 2021 Apr 1;27(2):369-401. Doi: 10.1212/CON.0000000000000931. PMID: 34351111

 

 

Comentario del experto

En este artículo se muestra la importancia de la interpretación correcta de todos los pequeños detalles de la historia clínica que pueden ayudar a interpretar las condiciones que causan episodios espontáneos recurrentes de mareos o vértigo, ya que los pacientes a menudo en el momento de la evaluación, están asintomáticos.

Se detalla la importancia de conocer los nuevos hallazgos que han servido para establecer criterios diagnósticos de consenso para la migraña vestibular, la enfermedad de Ménière, la paroxismia vestibular y el mareo/vértigo hemodinámico ortostático. 

Dr. Jesús Porta Etessam
Servicio de Neurología.
Hospital Clínico Universitario San Carlos. Madrid