Son sólo unos segundos, pero se hacen angustiosos para los que sufren vértigo, una sensación subjetiva de movimiento o de caída al vacío. Es tal la fuerza de este efecto que la persona que lo padece puede sufrir una caída, por lo que resulta especialmente preocupante en el caso de personas mayores.
El vértigo es una sensación subjetiva de rotación o desplazamiento. Los que lo sufren perciben una inclinación del suelo o sensación de precipitación en el vacío, aunque esta situación no ocurre realmente ni en el sujeto ni el entorno. Se trata de un síndrome multisensorial y sensomotor que puede causar graves perjuicios en la calidad de vida. A diferencia del mareo, el vértigo hace referencia siempre a una alteración del sistema vestibular (alojado en el oído interno y cuyo centro neurológico está en el tronco del encéfalo), mientras que el mareo no siempre está relacionado con éste. Aunque se trata también de un trastorno del equilibrio, el mareo suele englobar además sensación de malestar y de desmayo inminente, acompañado de náuseas y vómitos, sudoración fría y palidez.
No es un trastorno banal ni infrecuente, por ello los expertos reunidos en el 63º congreso de la Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial (SEORL-PCF) destacaron la necesidad de tratar el vértigo y el desequilibrio ya que constituyen uno de los principales motivos de caídas, sobre todo en ancianos. Se calcula que una de cada cuatro personas entre los 65-70 años sufre una caída al año, un porcentaje que se eleva al 35 % después de los 75. Fracturas de cadera, incapacidad, traumatismos y ansiedad o depresión son algunas de las consecuencias de las mismas.
También en el transcurso del Congreso Nacional de la Sociedad Española de Médicos de Atención Primaria (Semergen), se han llevado a cabo varios talleres que abordan este frecuente problema de salud. Como destaca el doctor Juan José Gomáriz, médico de Familia del Centro de Salud Lorca Sur (Murcia) y miembro del Grupo de Trabajo de Neurología de Semergen, “es uno de los síntomas más comunes en el ser humano, estando presente en el 10% de las consultas de Atención Primaria y en el 30 % de las consultas de otorrinolaringología”.
Poniendo cerco al problema
La prevalencia poblacional anual del vértigo se estima en un 5% (llega hasta un 23% si se consideran los datos epidemiológicos de los mareos), siendo el sexo femenino y la vejez factores de riesgo para padecer este trastorno, explican los expertos de Semergen. Entre los pacientes con vértigo mayores de 60 años, en un 20% de los casos la gravedad del trastorno puede afectar notablemente a sus actividades cotidianas.
El origen del vértigo puede situarse en el sistema nervioso central o a nivel periférico. El 80% de los pacientes que consultan por este problema en Atención Primaria presentan un vértigo de causa periférica, siendo los más habituales el vértigo posicional paroxístico benigno (VPPB), la enfermedad de Menière y el síndrome vestibular geriátrico. Enfermedades frecuentes, como la hipertensión arterial, los traumatismos cráneoencefálicos o las enfermedades isquémicas vestibulares, pueden favorecer la aparición de vértigo; en otras ocasiones, el problema tiene su origen en otras patologías menos habituales, como la epilepsia, la esclerosis múltiple o procesos tumorales en el cerebro.
Pero el uso de ciertos fármacos también puede provocar, como efecto secundario, el inicio de episodios de vértigo. Ciertos psicofármacos, antihipertensivos, antibióticos (como los aminoglicósidos o estreptomicina) pueden inducir este trastorno y, sobre todo, el abuso de alcohol es un factor desencadenante muy frecuente. Ante esta situación, y como consejos prácticos, el doctor Juan José Gomáriz, recomienda “no consumir alcohol ni tabaco durante las crisis de vértigo, ni utilizar fármacos que interfieran en el fenómeno natural de la compensación del sistema nervioso central”.
Una correcta revisión de la historia clínica (es importante determinar la duración, inicio, frecuencia, severidad, factores agravantes y síntomas asociados) y una simple exploración física permiten, en muchos casos, el diagnóstico de este síndrome; tal y como aconseja la doctora Inés Mª Luna, médico Residente de Medicina Familiar y Comunitaria del Centro de Salud Lorca Sur (Murcia) y miembro del Grupo de Trabajo de Neurología de Semergen, “se debe hacer una anamnesis y exploración física detalladas para excluir causas potencialmente graves”.
Cómo abordarlo
- El tratamiento dependerá de la causa que lo produce. En líneas generales se deberá seguir una dieta baja en sal y eliminar líquidos ya que, al acumularse en el oído interno, ocasionan el vértigo. Si con ello no es suficiente, el médico puede prescribir diuréticos con este mismo fin; betahistina, con el objeto de aumentar la circulación en el oído interno y reducir la excitabilidad de las neuronas vestibulares sin somnolencia; y antagonistas del calcio y protectores celulares frente a agentes tóxicos locales (trimetazidina), que actúan sobre el mecanismo implicado en el desarrollo de enfermedades con vértigo, pérdida de audición y acúfenos.
- Aproximadamente el 70% de los pacientes mejoran con un tratamiento médico y dietético adecuado. Cuando no es así, uno de los avances en este campo es el tratamiento intratimpánico para vértigos recurrentes con el que consigue controlar el vértigo en un 90% de los pacientes . Consiste en administrar directamente fármacos en el oído medio-interno a través de una punción timpánica. “Es un procedimiento sencillo,
indoloro, con anestesia local, que no requiere quirófano y con buenos resultados”, explica el doctor Herminio Pérez, presidente de la Comisión de Otoneurología de la SEORL-PCF. Se puede efectuar o bien con corticoides o bien con gentamicina. En algunos casos “con una sola sesión es suficiente”, añade. - Uno de los investigadores más destacados sobre el vértigo en el mundo, el doctor Adolfo Bronstein, del Imperial College de Londres, explica que las pruebas de exploración clínica ayudan al diagnostico diferencial entre las causas de desequilibrio dependientes del oído interno y las dependientes del cerebro. En un estudio publicado en la revista Neuropsychologia, en el que ha participado el doctor Bronstein, se demuestra que no sólo es la posición del cuerpo la que influye en el sentido de la verticalidad sino que también juegan un papel importante “los procesos mentales”, o la conciencia de cómo esté orientado el cuerpo.
- Existen nuevas técnicas de exploración instrumental para el diagnóstico del equilibrio, entre las que destaca el Video Head Impulse Test, “que logra de una forma sencilla la evaluación de la función del oído interno”, comenta el doctor Pérez. Consiste en un aparato que permite valorar movimientos oculares, que dependen de la buena actuación del oído interno, con un sencillo impulso de la cabeza.
- Además, no hay que olvidar que existen técnicas de rehabilitación del equilibrio consistentes en sencillos ejercicios para suplir el déficit en el funcionamiento del oído interno.
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