Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Akut Vertigo Semptomlu Pediatrik Hastaların Klinik ve Demografik Özelliklerinin Değerlendirilmesi: Tanımlayıcı Araştırma
Evaluation of Clinical and Demographic Characteristics of Pediatric Patients with Acute Vertigo Symptoms: Descriptive Research
Gül YÜCELa
aKonya Şehir Hastanesi, Çocuk Nörolojisi BD, Konya, Türkiye
Turkiye Klinikleri J Pediatr. 2022;31(3):151-9
doi: 10.5336/pediatr.2022-88518
Article Language: TR
Full Text
ÖZET
 Amaç: Çocuklar özellikle okul öncesi dönemde yakınmalarını ifade etmekte zorlandıkları için vertigo tanısında sıkıntı yaşanmaktadır. Bu çalışmada akut vertigo yakınması ile başvuran pediatrik hastaların demografik ve klinik özellikleri ile etiyolojik nedenlerin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Konya Şehir Hastanesi Çocuk Nöroloji polikliniğine Ocak 2019-Temmuz 2021 tarihleri arasında akut vertigo şikâyeti ile başvuran 258 hastanın kayıtları retrospektif olarak değerlendirildi. Bulgular: Hastaların %64,7'i (n=167) kız, %35,3'ü erkek, kız/erkek oranı:1,84 idi. Yaşları 2,5-18 yıl arasında olup, ortalama yaşları 12,96 ±3,28 yıldı. Hastaların %40'ı (1-6 yaş), %17,8'i (6-12 yaş) çocuk ve %42,2'si (12-18 yaş) ergendi. Tüm hasta grubunda; çocukluk çağının benign paroksismal vertigosu (%21,3), ortostatik hipotansiyon (%20,5), migren ilişkili vertigo (%18,2), psikojenik vertigo (%14,7) ve epileptik vertigo (%6,2) en sık görülen tanılardı. Benign paroksismal vertigo ≤ 6 yaş çocuklarda en sık görülen tanı iken, ≥12 yaş ergenlerde psikojenik vertigo hâkimdi (p<0,001). Epileptik vertigo çocuk yaş grubunda daha yüksekti ve hastaların yarısının altı yaş altında olduğu saptandı. Epileptik vertigo hastalarında dalma, sabit boş bakma, tepkisizlik gibi farkındalığın bozulduğu fokal nöbetler tanımlandı (p<0,001). Sonuç: Çocuklarda benign paroksismal vertigo, ergenlerde psikojenik vertigo en sık görülen tanılardır. Epileptik vertigo küçük çocuklarda daha sık görülür. Nöbetler belirgin epileptik özellikler olmasa bile vestibüler bulgulara neden olabilir. Küçük çocuklar arasında vertigo ortaya çıktığında epilepsi de düşünülmelidir.

Anahtar Kelimeler: Vertigo; çocuk; ergen; baş dönmesi; ayırıcı tanı
ABSTRACT
 Objective: There are difficulties in the diagnosis of vertigo because children have difficulty in expressing their vertigo complaints, especially in the pre-school period. In this study, it was aimed to evaluate the demographic and clinical characteristics and etiological causes of pediatric patients who presented with the complaint of acute vertigo. Material and Methods: The records of 258 patients who applied to the Konya City Hospital Pediatric Neurology outpatient clinic with the complaint of acute vertigo between January 2019-July 2021 were evaluated retrospectively. Results: Of the patients, 64.7% (n=167) were female, 35.3% male, female/male ratio was 1.84. Their ages were between 2.5-18 years, with a mean age of 12.96 ± 3.28 years. Of the patients, 40% (1-6 years), 17.8% (6-12 years) children, 42.2% (12-18 years) were adolescents. In the whole patient group; benign paroxysmal vertigo of childhood (21.3%), orthostatic hypotension (20.5%), migraine-associated vertigo (18.2%), psychogenic vertigo (14.7%) and epileptic vertigo (6.2%) were the most common diagnoses. Benign paroxysmal vertigo was the most common diagnosis in children ≤ 6 years of age while psychogenic vertigo prevailed in adolescent ≥12 years (p<0.001). Epileptic vertigo was higher in the pediatric age group and half of the patients were found to be under the age of six. Focal seizures with impaired awareness such as immersion, staring and unresponsiveness were defined in epileptic vertigo patients (p<0.001). Conclusion: Benign paroxysmal vertigo in children and psychogenic vertigo in adolescents are the most common diagnoses. Epileptic vertigo is more common in young children. Seizures may cause vestibular manifestations even without obvious epileptic features. Epilepsy should also be considered when vertigo emerged among younger children.

Keywords: Vertigo; child; adolescent; dizziness; differential diagnosis
REFERENCES:
  1. Bisdorff A, Von Brevern M, Lempert T, Newman-Toker DE. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res. 2009;19(1-2):1-13. [Crossref]  [PubMed] 
  2. Balatsouras DG, Kaberos A, Assimakopoulos D, Katotomichelakis M, Economou NC, Korres SG. Etiology of vertigo in children. Int J Pediatr Otorhinolaryngol. 2007;71(3):487-94. [Crossref]  [PubMed] 
  3. Erbek SH, Erbek SS, Yilmaz I, Topal O, Ozgirgin N, Ozluoglu LN, et al. Vertigo in childhood: a clinical experience. Int J Pediatr Otorhinolaryngol. 2006;70(9):1547-54. [Crossref]  [PubMed] 
  4. Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, Magliulo G, Re M. Prevalence and diagnosis of vestibular disorders in children: a review. Int J Pediatr Otorhinolaryngol. 2014;78(5):718-24. [Crossref]  [PubMed] 
  5. Gruber M, Cohen-Kerem R, Kaminer M, Shupak A. Vertigo in children and adolescents: characteristics and outcome. ScientificWorldJournal. 2012;2012:109624. [Crossref]  [PubMed]  [PMC] 
  6. Humphriss RL, Hall AJ. Dizziness in 10 year old children: an epidemiological study. Int J Pediatr Otorhinolaryngol. 2011;75(3):395-400. [Crossref]  [PubMed] 
  7. Brodsky JR, Lipson S, Bhattacharyya N. Prevalence of pediatric dizziness and imbalance in the United States. Otolaryngol Head Neck Surg. 2020;162(2):241-7. [Crossref]  [PubMed] 
  8. Duarte JA, Leão EM, Fragano DS, Marquez GJ, Pires APBÁ, Silva MLS, et al. Vestibular syndromes in childhood and adolescence. Int Arch Otorhinolaryngol. 2020;24(4):e477-81. [Crossref]  [PubMed]  [PMC] 
  9. Wiener-Vacher SR, Quarez J, Priol AL. Epidemiology of vestibular impairments in a pediatric population. Semin Hear. 2018;39(3):229-42. [Crossref]  [PubMed]  [PMC] 
  10. Cumberworth VL, Patel NN, Rogers W, Kenyon GS. The maturation of balance in children. J Laryngol Otol. 2007;121(5):449-54. [Crossref]  [PubMed] 
  11. O'Reilly R, Grindle C, Zwicky EF, Morlet T. Development of the vestibular system and balance function: differential diagnosis in the pediatric population. Otolaryngol Clin North Am. 2011;44(2):251-71, vii. [Crossref]  [PubMed] 
  12. Rodríguez-Villalba R, Caballero-Borrego M, Villarraga V, Rivero de Jesús V, Claveria MA, Haag O. Vestibulo-ocular reflex assessed with Video Head Impulse Test in children with Vestibular Migraine: Our experience. Int J Pediatr Otorhinolaryngol. 2020;137:110161. [Crossref]  [PubMed] 
  13. Kim KS, Jung YK, Hyun KJ, Kim MJ, Kim HJ. Usefulness and practical insights of the pediatric video head impulse test. Int J Pediatr Otorhinolaryngol. 2020;139:110424. [Crossref]  [PubMed] 
  14. Balzanelli C, Spataro D, Redaelli de Zinis LO. Prevalence of pediatric and adolescent balance disorders: analysis of a mono-institutional series of 472 patients. Children (Basel). 2021;8(11):1056. [Crossref]  [PubMed]  [PMC] 
  15. Casani AP, Dallan I, Navari E, Sellari Franceschini S, Cerchiai N. Vertigo in childhood: proposal for a diagnostic algorithm based upon clinical experience. Acta Otorhinolaryngol Ital. 2015;35(3):180-5. [PubMed]  [PMC] 
  16. Devaraja K. Vertigo in children; a narrative review of the various causes and their management. Int J Pediatr Otorhinolaryngol. 2018;111:32-8. [Crossref]  [PubMed] 
  17. Yılmaz A, Abseyi SN. Clinical and demographic characteristics of children and adolescents with acute vertigo symptoms: A cross-sectional study. Turk J Med Sci. 2020;50(8):1951-4. [Crossref]  [PubMed]  [PMC] 
  18. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629-808. [Crossref]  [PubMed] 
  19. Davitt M, Delvecchio MT, Aronoff SC. The differential diagnosis of vertigo in children: a systematic review of 2726 cases. Pediatr Emerg Care. 2020;36(8):368-71. [PubMed] 
  20. Batu ED, Anlar B, Topçu M, Turanlı G, Aysun S. Vertigo in childhood: a retrospective series of 100 children. Eur J Paediatr Neurol. 2015;19(2):226-32. [Crossref]  [PubMed] 
  21. Lee JD, Kim CH, Hong SM, Kim SH, Suh MW, Kim MB, et al. Prevalence of vestibular and balance disorders in children and adolescents according to age: a multi-center study. Int J Pediatr Otorhinolaryngol. 2017;94:36-9. [Crossref]  [PubMed] 
  22. McCaslin DL, Jacobson GP, Gruenwald JM. The predominant forms of vertigo in children and their associated findings on balance function testing. Otolaryngol Clin North Am. 2011;44(2):291-307, vii. [Crossref]  [PubMed] 
  23. Al-Twaijri WA, Shevell MI. Pediatric migraine equivalents: occurrence and clinical features in practice. Pediatr Neurol. 2002;26(5):365-8. [Crossref]  [PubMed] 
  24. Ralli G, Atturo F, de Filippis C. Idiopathic benign paroxysmal vertigo in children, a migraine precursor. Int J Pediatr Otorhinolaryngol. 2009;73 Suppl 1:S16-8. [Crossref]  [PubMed] 
  25. Krams B, Echenne B, Leydet J, Rivier F, Roubertie A. Benign paroxysmal vertigo of childhood: long-term outcome. Cephalalgia. 2011;31(4):439-43. [Crossref]  [PubMed] 
  26. Martín Sanz E, Barona de Guzmán R. [Benign paroxysmal vertigo of childhood: categorization and comparison with benign positional paroxysmal vertigo in adult]. Acta Otorrinolaringol Esp. 2007;58(7):296-301. [Crossref]  [PubMed] 
  27. Tanaka H, Yamaguchi H, Matushima R, Tamai H. Instantaneous orthostatic hypotension in children and adolescents: a new entity of orthostatic intolerance. Pediatr Res. 1999;46(6):691-6. [Crossref]  [PubMed] 
  28. 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. [Crossref]  [PubMed] 
  29. Marcelli V, Furia T, Marciano E. Vestibular pathways involvement in children with migraine: a neuro-otological study. Headache. 2010;50(1):71-6. [Crossref]  [PubMed] 
  30. Neuhauser H, Leopold M, von Brevern M, Arnold G, Lempert T. The interrelations of migraine, vertigo, and migrainous vertigo. Neurology. 2001;56(4):436-41. [Crossref]  [PubMed] 
  31. Langhagen T, Schroeder AS, Rettinger N, Borggraefe I, Jahn K. Migraine-related vertigo and somatoform vertigo frequently occur in children and are often associated. Neuropediatrics. 2013;44(1):55-8. [Crossref]  [PubMed] 
  32. Ketola S, Niemensivu R, Henttonen A, Appelberg B, Kentala E. Somatoform disorders in vertiginous children and adolescents. Int J Pediatr Otorhinolaryngol. 2009;73(7):933-6. [Crossref]  [PubMed] 
  33. Brandt T, Huppert D, Strupp M, Dieterich M. Functional dizziness: diagnostic keys and differential diagnosis. J Neurol. 2015;262(8):1977-80. [Crossref]  [PubMed] 
  34. Kluge M, Beyenburg S, Fernández G, Elger CE. Epileptic vertigo: evidence for vestibular representation in human frontal cortex. Neurology. 2000;55(12):1906-8. [Crossref]  [PubMed] 
  35. Tarnutzer AA, Lee SH, Robinson KA, Kaplan PW, Newman-Toker DE. Clinical and electrographic findings in epileptic vertigo and dizziness: a systematic review. Neurology. 2015;84(15):1595-604. [Crossref]  [PubMed]  [PMC] 

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