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Otorinolaringologia 2001 June;51(2):61-8

language: Italian

Vertigo from vascular origin: some pathogenetic hypotheses and therapeutic remarks

Tirelli G., Zarcone O., Giacomarra V., Bianchi M.

Università degli Studi - Trieste Dipartimento di Scienze Chirurgiche Specialistiche Unità Clinico Operativa di Otorinolaringoiatria


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Vertigo frequently affects patients who suffer from vertebrobasilar insufficiency. Vertigo attacks may be isolated or associated with other symptoms linked to vertebrobasilar insufficiency or to neurological signs and symptoms typical of encephalic or cerebellar ischemic necrosis. When vertigo is the sole symptom it is difficult to make a differential diagnosis with other vestibular pathologies.
The aim of this study was to understand when a vascular cause may be hypothesised as the origin of isolated vertigo and to evaluate the use and efficacy of an antithrombotic hemorrheological drug used to treat vertiginous syndromes with a probable vascular origin.
Methods. Thirty-two patients were selected with isolated symptoms of vertigo presenting risk factors for cardiovascular disease consisting of echo Doppler alterations of carotid or vertebrobasilar cerebral flow and/or CT ischemic alterations. The patients recruited were treated with sulodexide, a drug with antithrombotic, fibrinolytic and hemorrheological activity (250 ULS, 25 mg × 2/day) for 1 month; if there was no clinically significant response, treatment was continued for a further 30 days.
Results. The efficacy of treatment, evaluated using the Dizziness Handicap Inventory (DHI) Score, was 69% in patients receiving treatment. The continuation of therapy in non-responders did not lead to a significant clinical improvement.
Conclusions. The etiopathological classification of vertigo patients often reveals subjects who do not fit into the common vestibular pathologies; if these cases present precise risk factors for cardiovascular disease, it is possible to hypothesise a vascular origin of the disorder, even in the absence of other signs and symptoms of vertebrobasilar insufficiency. Treatment with an antithrombotic hemorrheological drug may be reasonably considered in these cases with the dual aim of improving the symptoms of vertigo and preventing the onset of cerebral ischemic complications.

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