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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
Otorinolaringologia 2005 December;55(4):237-46
Treatment of vascular vertigo in outpatients: multicentre experience (VascVert Study)
Servizio di Audio-Vestibologia e Rieducazione Vestibolare Azienda USL, Modena
Aim. Identifying the cause of equilibrium disorders is often difficult and the formulation of a hypothesis, particularly of vascular aetiology, is frequently based solely on medical history or biohumoral and neuroradiological markers. When vascular aetiology is suspected treatment with drugs that act on platelet aggregation, thrombogenesis, the microcirculation and haematic viscosity is required.
Methods. A retrospective study (VascVert Study) performed in 46 centres on 315 patients suffering from vertigo syndrome of vascular origin evaluated the characteristics of vertigo, its evolution and the effect of 2 treatments: antithrombotic (group SDX: sulodexide) and antiaggregant (group AAG: aspirin, ticlopidine).
Results. The most common risk factors were: arterial hypertension (71.7%), hypercholesterolaemia (64.1%), carotid disease (45.7%) and familial history of cardiac disease (59.7%). The different incidence of risk factors meant it was possible to identify a high vascular risk group (HR) and a low vascular risk group (LR). Two months of antiaggregant and antithrombotic treatment considered together significantly reduced cases of vertigo (from 90% to 61.1%) instability (from 88.9% to 54%), incidence of neurovegetative symptoms (from 45.7% to 20.6%), headache (from 34.6% to 19.7%) and improved bedside examination: Unterberg test (from 17.1% to 7.3%), head shaking test (from 23.5% to 9.5%), finger-to-nose test (4.8% to 2.2%) and spontaneous nystagmus (from 15.9% to 4.4%). Other symptoms, such as hypoacusis and tinnitus were not substantially modified. Quality of life was assessed using 2 questionnaires. Treatment significantly reduced the average global score of Dizziness Handicap Inventory (DHI) from 52 to 39 and the Disability Index from 0.44 to 0.33. Both treatments produced an improvement but it was significantly greater with sulodexide in the LR group and when both risk groups were combined. In the HR group no difference was observed between the antithrombotic and antiaggregant therapies.
Conclusion. The presence of vascular risk factors may back up a hypothesis of vascular vertigo and antithrombotic-antiaggregant treatment may significantly improve symptoms and reduce the degree of handicap and outbreaks of disequilibrium.