A child with vestibular neuritis. Is adenovirus implicated?
Department of Pediatrics, Section of Pediatric Neurology, Policlinico Le Scotte, University of Siena, Siena, Italy.Brain and Development (Impact Factor: 1.88). 08/2006; 28(6):410-2. DOI: 10.1016/j.braindev.2005.12.001
Vertigo in children is relatively under examined in the literature. Among its causes, vestibular neuritis (VN) represents only 2% of cases, with its etiology remaining unknown. We report for the first time a 4-year-old boy with vestibular neuritis and serological results compatible with adenoviral infection. Serological diagnosis was performed on the basis of a rise and consequent normalization of complement fixation (CF) titers of the plasma antibodies. Although we were not able to detect exactly when the infection started, we were able to detect an increased level of adenovirus antibodies by CF titers, followed by a decrease (i.e. 1/16, then 1/8, then <1/4) during the recovery. This is typical of a resolving infection. Furthermore, that this increase in antibodies was specific to an adenovirus infection was suggested by the observation that we did not detect increases in antibodies to other common viruses (i.e. herpes simplex and zoster viruses, Epstein-Barr virus, cytomegalovirus, influenza and parainfluenza viruses). This allows us to exclude the chance of nonspecific antibody activation. We concluded that, although our data do not formally demonstrate an involvement of adenovirus in VN, they suggest such an involvement. This may be of interest, given that a viral etiology for VN has been proposed but not definitively proven.
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ABSTRACT: Vestibular neuritis is a group of symptoms resulting from a sudden unilateral vestibular dysfunction. It seldom occurs in children (approximately 7%). Its etiology and pathogenesis are unknown, although most researchers consider viral infection to be a causative factor. The clinical symptoms appear rapidly, exacerbate within a few hours and include vertigos, accompanied by nausea, vomiting and paralytic nystagmus, which intensifies with head movements. This is a case of a 15-year-old boy, so far healthy and with normal psychomotor development, who was admitted to the hospital ward due to exacerbating vertigos accompanied by nausea and balance disorders.
Article: Etiology of vertigo in children[Show abstract] [Hide abstract]
ABSTRACT: To detect the most common causes of vertigo in children. Fifty-four children (20 boys and 34 girls) aged 3-16 years, who presented with vertigo attacks during a 3-year period, were studied. A detailed medical history for vestibular symptoms and migraine was obtained from our patients or their parents. All patients underwent otolaryngologic, ophthalmologic and neurologic clinical evaluation. A detailed laboratory examination, including serologic tests for viral infections, was also obtained. Additionally, a complete audiological and neurotologic evaluation was performed. Computed tomography (CT) scans and magnetic resonance imaging (MRI) were obtained in selected cases. Viral infections, benign paroxysmal vertigo of childhood and migraine were the most common causes of vertigo accounting for approximately 65% of our patients. Otitis media, head trauma, benign paroxysmal positional vertigo, Meniere's disease and brain tumor were less common causes of vertigo. A peripheral type of vertigo was found in most cases. Diagnostic approach in vertigo in children should include a detailed history and clinical examination in conjunction with a test battery of audiological and neurotologic tests. When a central cause of vertigo is suspected an MRI or CT scan should be ordered.
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ABSTRACT: Evaluation of children with vestibular complaints may be challenging. The approach to these patients is often quite different than the approach to adults with similar complaints. This review will discuss the evaluation of pediatric vestibular disease with an emphasis on recent evidence in the literature Recent evidence has elucidated the most common etiologies of vertigo in children, documented the utility and feasibility of objective diagnostic testing such as electronystagmography and vestibular evoked myogenic potentials in this population, and demonstrated the efficacy of new therapies such as rizatriptan for the treatment of migraine in children. An evidence-based approach to the evaluation of pediatric vestibular dysfunction may improve diagnostic yield and facilitate timely initiation of appropriate therapy.
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