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Advisor(s)
Abstract(s)
O equilíbrio corporal depende essencialmente da contribuição de três principais sistemas:
o visual, o vestibular e o propriocetivo. Qualquer anomalia ao longo destes sistemas ou a
nível encefálico, onde é feita a análise e integração das diversas informações, pode
despoletar uma perturbação do equilíbrio. Para descrever essa perturbação, geralmente o
doente menciona a tontura, como queixa no atendimento agudo. Contudo, sabe-se que esta
queixa pode ser a tradução de sensações muito distintas. As principais categorias associadas
a alterações do equilíbrio, são frequentemente: a vertigem, o desequilíbrio, a pré-síncope e
um grupo abrangente de tontura inespecífica. A tontura constitui portanto, uma causa
muito frequente de procura de ajuda médica, sendo um sintoma muito inespecífico. Perante
um doente com esta queixa, o examinador deve ser capaz de identificar a real sensação
envolvida, através de uma anamnese detalhada. Isto permitirá o enquadramento num dos
grupos anteriores, o que será fundamental para auxiliar no diagnóstico diferencial.
Para efeitos da prática clínica, a identificação da categoria Vertigem, assume particular
destaque, já que pode predizer situações ameaçadoras de vida, que exigem identificação e
tratamento precoces. Isolada ou acompanhada de outros sintomas/ sinais clínicos, pode
advir de lesões em diversas localizações, como o ouvido interno ou níveis mais centrais,
como o tronco cerebral.
Esta dissertação, pretende essencialmente através de algoritmos simples e práticos, orientar
e dirigir o raciocínio do examinador no sentido da entidade clínica envolvida, perante um
doente com queixa de tontura. Para a sua elaboração serão tidos em conta os achados mais
frequentes, quer da clínica quer do exame objetivo, referentes às patologias que poderão
estar em causa, segundo a literatura científica.
Body balance depends essentially on the contribution of three main systems: the visual, the vestibular and the proprioceptive. Any anomaly along these systems, or at the brain level where the analysis and integration of the various information is made, can trigger a disturbance of the balance. To describe this disorder, the patient usually mentions dizziness as a complaint in acute care. However, it is known that this complaint may be the translation of different sensations. The main categories associated with changes in balance are often vertigo, imbalance, pre-syncope, and a embracing group of nonspecific dizziness. Dizziness is therefore a frequent cause of seeking medical help, being a very nonspecific symptom. In the presence of a patient with this complaint, the examiner must be able, through a detailed anamnesis, to identify the real sensation involved. This will allow the inclusion in one of the previous groups, which will be essential to assist in the differential diagnosis. For the purposes of clinical practice, the identification of the Vertigo category is particularly important, as it can predict life-threatening situations that require early identification and treatment. Isolated or accompanied by other clinical symptoms / signs, it can result from injuries in several locations, such as the inner ear or more central levels, such as the brain stem. This dissertation intends essentially through simple and practical algorithms, to guide and direct the reasoning of the examiner towards the clinical entity involved, in front of a patient complaining of dizziness. For its elaboration, the most frequent findings, both from the clinic and from the physical examination, regarding the pathologies that may be in question, will be considered.
Body balance depends essentially on the contribution of three main systems: the visual, the vestibular and the proprioceptive. Any anomaly along these systems, or at the brain level where the analysis and integration of the various information is made, can trigger a disturbance of the balance. To describe this disorder, the patient usually mentions dizziness as a complaint in acute care. However, it is known that this complaint may be the translation of different sensations. The main categories associated with changes in balance are often vertigo, imbalance, pre-syncope, and a embracing group of nonspecific dizziness. Dizziness is therefore a frequent cause of seeking medical help, being a very nonspecific symptom. In the presence of a patient with this complaint, the examiner must be able, through a detailed anamnesis, to identify the real sensation involved. This will allow the inclusion in one of the previous groups, which will be essential to assist in the differential diagnosis. For the purposes of clinical practice, the identification of the Vertigo category is particularly important, as it can predict life-threatening situations that require early identification and treatment. Isolated or accompanied by other clinical symptoms / signs, it can result from injuries in several locations, such as the inner ear or more central levels, such as the brain stem. This dissertation intends essentially through simple and practical algorithms, to guide and direct the reasoning of the examiner towards the clinical entity involved, in front of a patient complaining of dizziness. For its elaboration, the most frequent findings, both from the clinic and from the physical examination, regarding the pathologies that may be in question, will be considered.
Description
Keywords
Abordagem à Tontura Desequilíbrio Etiologia da Vertigem Pré-Síncope Vertigem Central Vertigem Periférica