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| LETTER TO EDITOR |
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| Year : 2022 | Volume
: 7
| Issue : 2 | Page : 329-330 |
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The burden of the unnoticed rotational motion disorder
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
Department of Medicine, Federal University of Santa Maria, Santa Maria - RS, Brazil
| Date of Submission | 17-Feb-2022 |
| Date of Decision | 30-Apr-2022 |
| Date of Acceptance | 02-Jun-2022 |
| Date of Web Publication | 09-Sep-2022 |
Correspondence Address:
Jamir Pitton Rissardo
Av. Roraima, 1000 - Camobi, Santa Maria - RS
Brazil
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/bjhs.bjhs_32_22
How to cite this article:
Rissardo JP, Fornari Caprara AL. The burden of the unnoticed rotational motion disorder. BLDE Univ J Health Sci 2022;7:329-30 |
Sir,
We read the article entitled “acute brain stem vertigo without neurological deficits” in the acclaimed “BLDE University Journal of Health Sciences” with great interest. Swain reported an elderly male with 3 h of the onset of isolated vertigo.[1]
In the context of emergency medicine and general practice, unsteadiness, dizziness, and vertigo are frequent symptoms and should be thoroughly assessed. In this context, vertigo could be classified as peripheral or central, depending on the location of the pathway dysfunction within the vestibular system. These two etiologies should be efficiently and expeditiously differentiated because the diagnosis and management of vertigo are associated with its cause.[2] Here, we would like to discuss the recent literature about vertigo.
Ruthberg et al. aimed to estimate the added economic burden of vertigo and dizziness in several health-care services sectors in the United States. A retrospective analysis of data from the Medical Expenditure Panel Survey (2007–2015) was done. Most of the patients who manifested vertigo during this period were female, older, non-Hispanic Caucasian, publicly insured, and had significant clinical comorbidities. The total annual medical expenditures for both diseases were $48.1 billion. The mean incremental annual health-care expenditure directly related to vertigo or dizziness was $2658.73.[3] Thus, over the last decade, vertigo has been associated with a significant increase in economic and social burdens. It is noteworthy that this study did not assess costs secondary to decreased productivity, unemployment, and even occupational disability.
A recent genome-wide association study assessing the broad phenotype of vertigo in 48,072 cases revealed six sequence variants linked to a higher risk of vertigo. Skuladottir et al. reported the missense mutations, in which a point mutation results in the codification of a different amino acid, in ZNF91, OTOG, OTOGL, and TECTA, and a cis-eQTL for ARMC9. The increase in variance explained was 0.26% (ΔR2 = 0.0026, P = 1.4 × 10 − 50, odds ratio = 6.52).[4] The discovery of new variants may contribute to the elucidation of vertigo pathophysiology so that new pharmacological targets and drugs can be developed. Furthermore, these mutations may help in the initial screening of vertigo etiologies and the differentiation between central and peripheral lesions.
Dizziness is estimated to be the cause of almost 5% of total emergency department visits. Posterior circulation strokes, which are associated with a high mortality rate, represent approximately 3% of individuals with this symptom. Due to a multitude of complex factors, such as time constraints, limited resources, and a lack of a structured predetermined clinical flowchart, many patients presenting with vertigo in the emergency department leave without a definitive diagnosis of their pathology and do not receive appropriate follow-up. Nham et al. assessed the use of “Quantitative-HINTS plus” (Head-Impulse (HI), nystagmus (N), and test of skew quantified by video-HI, N-video-oculography, and audiometry) for acute vestibular syndrome. They observed a two-fold increase in the diagnostic rates of acutely vertiginous clinical manifestation with a structured investigation.[5] It is worthy of mentioning that the available time to perform these procedures, the record-devices costs, and the lack of further evaluation of vertigo patients is still important limitations in the majority of rural low-resource settings and emergency department centers.
Tramontano et al. explored the effects of osteopathic manipulative treatment in managing patients with vertigo and other balance disorders. They observed a weak positive effect of this type of treatment on balance disorders through different outcomes. Thus, alternative therapeutical options, in addition to conventional medicine, should be encouraged in clinical practice for patients that do not respond to conventional therapy. Other evidence-based complementary medicine options could be symptom-based structured assessment tools in association with counseling and integrated clinical implementation of the biopsychosocial model by incorporating a mindfulness-based approach.[6]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Swain SK. Acute brain stem vertigo without neurological deficits. BLDE Univ J Health Sci 2021;6:206-8.  [Full text] |
| 2. | Rissardo JP, Fornari Caprara AL. Isolated infarction of the tonsil in the cerebellum. Neurol India 2019;67:326-8. [ PUBMED] [Full text] |
| 3. | Ruthberg JS, Rasendran C, Kocharyan A, Mowry SE, Otteson TD. The economic burden of vertigo and dizziness in the United States. J Vestib Res 2021;31:81-90. |
| 4. | Skuladottir AT, Bjornsdottir G, Nawaz MS, Petersen H, Rognvaldsson S, Moore KH, et al. A genome-wide meta-analysis uncovers six sequence variants conferring risk of vertigo. Commun Biol 2021;4:1148. |
| 5. | Nham B, Reid N, Bein K, Bradshaw AP, McGarvie LA, Argaet EC, et al. Capturing vertigo in the emergency room: Three tools to double the rate of diagnosis. J Neurol 2022;269:294-306. |
| 6. | Tramontano M, Consorti G, Morone G, Lunghi C. Vertigo and balance disorders – The role of osteopathic manipulative treatment: A systematic review. Complement Med Res 2021;28:368-77. |
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