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~~~~~~~~~~~~~~~~  E  ;  P+sZCU 4  3@))=c6N3!Rl +; M.+ - =3a a      a  $" &r<dH  $'  28- v<B4 g ^  ?++D  -9 +4       . !b$s#ڿE`"  k$k2$J4s[]6Q v kb$*@tqeT p kb$ t40c k"$uFk+x%Kkb$b0#k"$;W[-LB#k"$Qq_}yNqU?k"$ҷbPs_P[kb$젗.2B@3sk t0e0e    A A5% 8c8c     ?A)BCD|E||S" 3@ʚ;2Nʚ;g4FdFdv 0PPp@pP <4!d!d` 0L[<4dddd` 0L[ <4dddd 0Lg4=d=dv 0.p po0___PPT10 ppZ___PPT9<%hlp#$$$&11111z(? %O =%s$Epidemiologa del mareo y el vrtigo$%" fff%&$fff$  ( t Antecedentes  Los vrtigos y otros tipos de mareos son un motivo de consulta frecuente en atencin primaria que requieren un diagnstico diferencial, aunque un elevado porcentaje quedan sin un diagnstico preciso, puesto que, aunque en la mayor parte de los casos se trata de problemas banales, en ocasiones pueden ser sntoma de una enfermedad importante. Pese a ello, existen pocos estudios sobre la epidemiologa de estos sntomas. B% 6 O %6Ou Objetivos  Estudiar la carga que supone el sntoma del mareo y el vrtigo vestibular en una muestra representativa de la poblacin general alemana.  v Diseo (1)  0Estudio transversal. El estudio se llev a cabo en el marco de la Encuesta Nacional de Salud de Alemania de 2003. Se seleccion una muestra representativa de la poblacin alemana. Entre las preguntas incluidas en el cuestionario, una interrogaba sobre si senta mareo o vrtigo moderado o grave. A los pacientes que contestaban afirmativamente se les invitaba a participar en una entrevista neurolgicaestructurada para diferenciar entre vrtigos vestibulares y otros tipos de mareos basndose en criterios explcitos para identificar trastornos concretos. .10ZB&|w Diseo (2)  -Se consider que el paciente tena un vrtigo vestibular si tena vrtigo rotatorio, vrtigo posicional o tena un mareo con nuseas e inestabilidad. Tambin se incluan preguntas para diagnosticar: vrtigo de Menire, vrtigo migraoso, mareo ortosttico y vrtigo posicional paroxstico benigno.. f fb\ k    Diseo (3)  Otras preguntas del cuestionario estaban dirigidas a valorar: sensacin de enfermedad, ingresos hospitalarios, conductas de evitacin, utilizacin de servicios sanitarios a causa del mareo y calidad de vida relacionada con la salud medida mediante el SF-8. .>  >xResultados (2)Prevalencia del mareo-vrtigo de intensidad al menos moderada: a lo largo de la vida: 29%, anual: 23%. Casi todos los que afirmaron presentar mareos-vrtigos en el ao del estudio referan ataques recurrentes. En 2/3 partes de los casos resultaron altamente invalidantes. El 2% de los adultos haban consultado con su mdico (sobre todo de atencin primaria) por este motivo. La prevalencia fue superior en las mujeres que en los varones. <?*T?*T6  n 3Resultados (3)El vrtigo vestibular fue el responsable del 36% de los mareos que se dieron en los pacientes que haban consultado con el mdico. El porcentaje debido a este trastorno aument con la edad. Este trastorno ocasionaba: ms consultas al mdico, una mayor sensacin de enfermedad, ms interrupciones de las actividades de la vida diaria y ms confinamientos en casa que los mareos no vestibulares. DZZ#Z# ConclusionesLos autores concluyen que: el mareo es un problema frecuente que supone una elevada carga tanto para los pacientes como para el sistema sanitario, por lo que su diagnstico diferencial es un tema prioritario en atencin primaria. &0Comentario (1)El mareo es el principal motivo de consulta de una de cada 40 visitas de adultos en atencin primaria. Las causas de este sntoma son muy variadas, por lo que el conocimiento de su epidemiologa puede ser de ayuda a la hora de orientar el diagnstico. Sin embargo, se han publicado pocos trabajos sobre este aspecto. Los puntos fuertes de este trabajo son: basarse en una muestra representativa de la poblacin adulta y haber utilizado criterios explcitos para diagnosticar los diferentes tipos de mareos. .gZZgeComentario (2)Sin embargo, el hecho de basarse en una entrevista telefnica ha limitado la capacidad de llegar a diagnsticos concretos de determinados tipos de mareos. Una tercera parte se deban a algn tipo de vrtigo vestibular, que se confirma que es un trastorno invalidante. Entre stos, los ms frecuentes fueron los vrtigos paroxsticos posicionales benignos, que, a su vez, supusieron una tercera parte de los vestibulares. Ms sorprendente resulta que la segunda causa de vrtigo vestibular fuese el vrtigo migraoso.  Z > C  fComentario (3)FEl vrtigo migraoso se define como: presencia de sntomas episdicos de vrtigo vestibular (sensacin de rotacin o de movimiento de los objetos o intolerancia a los movimientos de la cabeza), en personas afectas de migraa y e"1 sntoma de migraa en e"2 ataques de vrtigo. Los ataques duran entre varias horas y varias semanas. Lo ms frecuente es que los sntomas migraosos empiecen simultneamente al vrtigo. <%%>  'pComentario (4)Los ms frecuentes son la cefalea y la fotofobia. El vrtigo puede ser constante, aunque en muchos pacientes presenta exacerbaciones posicionales. Es infrecuente la presentacin de sntomas auditivos. Un porcentaje elevado presentan: nistagmus, alteraciones de la marcha y Romberg alterado. 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