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Síndrome vestibular central e periférica em cães e gatos
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A síndrome vestibular é das emergências neurológicas mais frequentes em clínica de animais de companhia. Trata-se de uma disfunção neurológica caraterizada fundamentalmente pela perda de equilíbrio e incapacidade de coordenar a posição da cabeça com o corpo. O aparelho vestibular é um sistema de proprioceção especial, encontrando-se dividido em periférico e central, com estruturas localizadas no ouvido interno e no tronco cerebral e cerebelo, respetivamente. Tem como principal função estabilizar a cabeça, corpo e membros em relação à gravidade, mantendo uma postura corporal coordenada, e adaptar a posição dos olhos durante o movimento da cabeça, obtendo uma imagem visual fixa. Os sinais clínicos mais comuns são head tilt, ataxia vestibular e nistagmo, podendo existir também síndrome de Horner, paralisia do nervo facial, alterações de estado mental, défices propriocetivos e de outros pares cranianos para além do nervo vestibulococlear. A neurolocalização da lesão é essencial para a elaboração da lista dos diagnósticos diferenciais e respetiva escolha de exames complementares de diagnóstico, tratamento e prognóstico. As patologias associadas a lesões centrais mais frequentes são neoplasia intracraniana, inflamação e infeção do sistema nervoso central, enquanto que no caso de lesões periféricas são otite média/interna e ainda patologia idiopática. O tratamento depende da etiologia associada, sendo de grande relevância o tratamento de suporte, assim como o prognóstico apresenta grande variabilidade consoante a causa da lesão vestibular. Devido à elevada diversidade de diagnósticos diferenciais de síndrome vestibular, é importante que exista constante investigação de forma a esclarecer as suas etiologias e mecanismos de doença.
Vestibular disease is one of the most frequent neurologic emergencies in small animal practice. It’s a neurologic dysfunction characterized by loss of balance and incapacity to maintain a normal head and body posture. The vestibular apparatus is a special proprioception system, divided into peripheral and central components, inner ear and brainstem and cerebellum, respectively. Its main function is to stabilize head and body in space, maintaining balance, and adapting the eye’s position during head movement to maintain the visual image. Common clinical signs include head tilt, vestibular ataxia and nystagmus, and can be accompanied by Horner syndrome and facial nerve paralysis in peripheral lesions, and mentation changes, proprioception deficits and other cranial nerve deficits, besides vestibulocochlear nerve, if a central lesion is present. Neuroanatomic localization of the lesion is essential to determine the cause, diagnostic approach, treatment and prognosis. Most common diseases causing central vestibular signs are intracranial neoplasia and inflammatory or infectious diseases, while peripheral vestibular signs are frequently caused by otitis media and otitis interna and idiopathic disease. Treatment depends on the underlying disease and supportive care is always important in the vestibular patient management. Prognosis is also dependent on the neuroanatomic diagnosis and is very variable. Due to the great diversity of differential diagnosis in vestibular disease, constant research is very important for further elucidation regarding etiologies and disease mechanisms.
Vestibular disease is one of the most frequent neurologic emergencies in small animal practice. It’s a neurologic dysfunction characterized by loss of balance and incapacity to maintain a normal head and body posture. The vestibular apparatus is a special proprioception system, divided into peripheral and central components, inner ear and brainstem and cerebellum, respectively. Its main function is to stabilize head and body in space, maintaining balance, and adapting the eye’s position during head movement to maintain the visual image. Common clinical signs include head tilt, vestibular ataxia and nystagmus, and can be accompanied by Horner syndrome and facial nerve paralysis in peripheral lesions, and mentation changes, proprioception deficits and other cranial nerve deficits, besides vestibulocochlear nerve, if a central lesion is present. Neuroanatomic localization of the lesion is essential to determine the cause, diagnostic approach, treatment and prognosis. Most common diseases causing central vestibular signs are intracranial neoplasia and inflammatory or infectious diseases, while peripheral vestibular signs are frequently caused by otitis media and otitis interna and idiopathic disease. Treatment depends on the underlying disease and supportive care is always important in the vestibular patient management. Prognosis is also dependent on the neuroanatomic diagnosis and is very variable. Due to the great diversity of differential diagnosis in vestibular disease, constant research is very important for further elucidation regarding etiologies and disease mechanisms.
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Keywords
Disfunção vestibular Equilíbrio Periférico Central Cão Gato Vestibular dysfunction Balance Peripheral Dog Cat