A queixa de tontura ou de vertigem é muito frequente na população geral e a falta de compreensão mínima de seus mecanismos causadores leva a uma grande confusão, tanto por parte dos pacientes quanto por parte de muitos médicos. Isso se deve ao fato de muitas condições sistêmicas, distúrbios do ouvido interno (labirinto) e alterações em estruturas neurológicas se manifestarem dessa forma. Muitas vezes os próprios pacientes têm dificuldade em explicar com precisão seus sintomas, o que torna a tarefa do médico ainda mais difícil.
Chamamos de tontura, a sensação de mal-estar inespecífico, turvação ou escurecimento visual, fraqueza ou uma sensação de “quase desmaio”. A vertigem mais especificamente se refere a uma percepção equivocada dos movimentos do próprio corpo ou do ambiente, muitas vezes percebida como se o paciente ou o ambiente estivesse girando, se inclinando ou flutuando. É comum que a tontura e a vertigem venham acompanhadas de náuseas e vômitos e uma sensação de desequilíbrio.
Estes sintomas são causadores de 4 a cada 100 atendimentos nas emergências e são a 3ª maior causa de procura pelo atendimento de Neurologia, ficando atrás somente das dores de cabeça e alterações de força muscular e a frente das crises convulsivas. Em 30% dos casos, a tontura e a vertigem são manifestações de condições potencialmente graves, que podem colocar em risco a vida do paciente. Dentro das condições clínicas que se manifestam com tontura e vertigem estão a queda da pressão arterial, arritmias, anemias, hipoglicemia, insuficiência cardíaca congestiva e infecções sistêmicas.
Das causas neurológicas, 11% dos pacientes que se apresentam apenas com vertigem, sem nenhum outro sintoma associado, têm AVC, que é o principal diagnóstico a ser descartado em casos de tontura ou vertigem que se iniciam abruptamente e persistem por mais de 1 hora. Outra condição neurológica muito frequente na população geral e frequentemente chamada equivocadamente pelos pacientes de “labirintite”, é a Vertigem Posicional Paroxística Benigna, conhecida como VPPB, em que os episódios de vertigem são recorrentes, de curta duração, desencadeados por movimentos da cabeça e acompanhados de náuseas ou vômitos.
A enxaqueca vestibular é outra causa de tontura e vertigem, com pelo menos 50% dos episódios de vertigem acompanhados por dores de cabeça e outros sintomas comuns nos quadros de enxaqueca, como sensibilidade à luz, aos ruídos e a piora da dor ao realizar movimentos corporais e atividades físicas. Existem outras causas neurológicas mais raras de tontura e vertigem como a doença de Meniére, a Vertigem Fóbica, a Paroxismia Vestibular (contato anormal de uma artéria com o nervo vestibular no tronco encefálico) e as Fístulas Perilinfáticas.
Se você sofre de tontura ou vertigem, ou ambas, procure um médico neurologista. Para um correto diagnóstico, o médico precisa caracterizar corretamente os sintomas do paciente, seus fatores desencadeantes, sua duração e outros sintomas associados, além de realizar exame físico e manobras vestibulares que podem ser feitas no consultório.
Como podemos perceber, nem toda tontura ou vertigem é “labirintite”.
Neurologista, Daniel Giffoni (CRM-PE: 29137 RQE: 9719)
Formei em Neurologia pelo Hospital das Clínicas da Universidade Federal de Minas Gerais – HC-UFMG. Atualmente cursando Neurofisiologia clínica.
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