Avaliação vestibular no tremor essencial
Vestibular evaluation in the essential tremor
Bianca Simone Zeigelboim; Cláudia Mittelmann
Resumo
Tema: o tremor essencial é familial em cerca de 50% dos casos, com uma herança autossômica, possui início insidioso e é lentamente progressivo.
Procedimentos: avaliou-se no Setor de Otoneurologia de um Hospital Particular em fevereiro de 2007, uma paciente do sexo feminino, branca, 59 anos, casada, artista plástica, com história de tremor na cabeça desde os dois anos de idade (sic). A paciente relata queixa de tontura há vários meses de origem súbita sem acompanhamento de náusea e/ou queda. Nega perda de força muscular e formigamento em membros superiores e inferiores, rebaixamento da acuidade auditiva e zumbido. A paciente relata que um de seus filhos possuiu tremor nas mãos há dois anos e avós maternos e paternos com Parkinson. Realizaram-se os seguintes procedimentos: anamnese, inspeção otológica e avaliação vestibular por meio da vectoeletriostigmografia.
Resultados: observaram-se os seguintes achados ao exame vestibular: nistagmo de posicionamento com características centrais, nistagmo espontâneo presente com os olhos abertos, nistagmo semi-espontâneo do tipo múltiplo e hiper-reflexia em valor absoluto à prova calórica 20ºC (OD e OE).
Conclusão: o exame vestibular mostrou-se sensível e importante para captar alterações em provas que sugerissem envolvimento do sistema nervoso central.
Palavras-chave
Abstract
Background: essential tremors are family-related in about 50% of the cases with an autosomal inheritance and they register an insidious beginning with a slow progression.
Procedure: a 59 year old, white female patient, married and whose occupation is a plastic artist with a history of head tremors since she was two years (sic) old was evaluated in the Otoneurology sector of a private hospital, during the period from February 2007. The patient had been complaining of dizziness from unknown origin for several months without accompanying nausea and/or falls. She denied any loss of muscular strength or tingling in her upper and lower members and neither any lowering of her auditory sharpness nor buzzing. The patient informed that one of her children suffered hand tremors two years ago and also that both grandparents had Parkinson's disease. The following procedures were performed: anamnesis, otological inspection and vestibular evaluation through vectoelectronystagmography.
Results: the following findings from the vestibular exam were observed: positioning nystagmus with central characteristics, spontaneous nystagmus with the eyes open, semi-spontaneous nystagmus of the multiple and hyperreflexia type in readings absolute to the caloric test at 20°C (RE and LE).
Conclusion: the vestibular exam was shown to be sensitive and important for garnering alterations in tests that suggested involvement of the central nervous system.
Keywords
Referências
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Submetido em:
14/05/2007
Aceito em:
22/04/2008
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