Zoya İrfan KHAN, Sushil Ghanshyam Kachewar

Baş dönmesinin değerlendirilmesinde 1.5 teslalık manyetik rezonans görüntüleme beyin çalışmasının yararlılığı: geriye dönük 500 olguluk bir çalışma

Amaç: Bu çalışmanın amacı baş dönmesi sebeplerinin değerlendirilmesinde 1.5 tesla magnetik rezonans beyin görüntüleme çalışmasının faydasını değerlendirmektir.Gereç ve Yöntem: Geçmişe yönelik bu analitik çalışmada baş dönmesi görülen 500 hastanın MRG beyin taramaları baş dönmesi sebeplerini belirleyebilmek için analiz edildi.Bulgular: 500 MRG seri taramaları incelendi. Cinsiyet bilgisi yaşları 36 ile 74 arasında değişen 288 kadın ve 212 erkek olarak belirlendi. 272 tarama (%54.4) tamamen normal olarak bildirildi. Mastoiditlerin göz önünde bulundurulmadığı 52 vakada (%10.4) önemli bulgular görüldü. Mastoidit baş dönmesinin olası sebebi kabul edildiğinde önemli bulgular 284 vakada, yani vakaların %56.8'inde görülmektedir. En sık rastlanan tesadüfi bulgular; 136 taramada (%27.2) iskemik odaklar, 144 taramada (%28.8) eski infarktüsler, 177 olguda (%35.4) görülen serebral atrofilerdir. 77 taramada ise (%13.5) ileri değerlendirmeye ihtiyaç duyulan klinik olarak ciddi rastlantısal bulgular saptanmıştır.Sonuç: Diğer çalışmalarda bahsedilen MRG’nin yüksek duyarlılık ve özgüllük; rutin ilaç tedavisine yanıt vermeyen baş dönmesi olan hastaların incelenmesinde kullanılımını doğrulamaktadır. Bu hastalarda MRG taraması direkt olarak baş dönmesine sebep olan önemli bulguları başarıyla gösterebilmektedir. Fakat bu bulguların sıklığı oldukça azdır. Çoğu zaman klinik açıdan önemli olabilen veya klinik açıdan önemli olmayan rastlantısal bulgular gösterilebir. Maliyetli bir inceleme olan MRG bu özelliği nedeniyle böylesi hastalarda sağduyulu bir şekilde kullanılmalıdır.

Anahtar Kelimeler:

Beyin, baş dönmesi

Utility of 1.5 tesla magnetic resonance imaging brain study in evaluating giddiness: a retrospective study of 500 cases

Purpose: The purpose of this study was to evaluate the utility of 1.5 tesla magnetic resonance imaging (MRI) brain studies in evaluating the cause of giddiness.Materials and methods: In this retrospective analytical study; MRI brain scans of 500 patients who presented with giddiness; were analysed to assess if the cause of giddiness could be found in them.Results: Five-hundred MRI serial scans were reviewed. Gender wise total 288 females and 212 males with age ranging between 36 to 74 years were found. Two hundred and seventy two scans (54.4%) were reported as completely normal. Significant findings were seen in 52 cases (10.4%); when mastoiditis was not taken into account. When mastoiditis was included as a possible cause of giddiness, the significant findings were seen in 284 cases (56.8%) of cases. The most frequent incidental finding were cerebral atrophy in 177 cases (35.4 %), old infarcts in 144 scans (28.8%) and ischemic foci in 136 scans (27.2%). Seventy seven scans (13.5%), had clinically serious incidental findings that needed further management. Conclusion: High sensitivity and specificity of the MRI mentioned in other studies justifies its use in investigating patients with giddiness that do not respond to routine medications. MRI scans in such patients can successfully demonstrate the significant findings - which can directly cause giddiness. But incidence of such findings is very less. Most often, incidental findings are demonstrated which may or may not be clinical significance. MRI being a costly investigation, should therefore be used judiciously in such patients.

Keywords:

Brain, dizziness,

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Neuhauser HK, Lempert T. Vertigo: epidemiologic aspects. Semin Neurol. 2009;29:473–81.
Bronstein AM, Lempert T. Management of the patient with chronic dizziness. Restor. Neurol. Neurosci. 2010;28: 83–90.
Chan Y. Differential diagnosis of dizziness. Curr Opin Otolaryngol Head Neck Surg. 2009;17:200–3.
Mirza S, Malik TH, Ahmed A, Willatt DJ, Hughes DG: Incidental findings on magnetic resonance imaging screening for cerebello-pontine angle tumours. J Laryngol Otol. 2000;114:750-4.
Katzman GL, Dagher AP, Patronas NJ: Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA. 1999;282:36- 9.
Yue NC, Longstreth WT Jr, Elster AD, Jungreis CA, O'Leary DH, Poirier VC: Clinically serious abnormalities found incidentally at MR imaging of the brain: data from the Cardiovascular Health Study. Radiology. 1997;202:41-6.
Jack CR Jr: MR imaging of the brain in epidemiologic research: the Cardiovascular Health Study. Radiology. 1997;202:17-9.
Meike W, Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A et al: Incidental findings on brain MRI in the general population. N Engl J Med. 2007;357:1821-8.
Robson AK, Leighton SE, Anslow P, Milford CA: MRI as a single screening procedure for acoustic neuroma: a cost effective protocol. J R Soc Med. 1993;86:455-7.
Raber E, Dort JC, Sevick R, Winkelaar R: Asymmetric hearing loss: toward cost-effective diagnosis. J Otolaryngol. 1997;26:88-91.
Kwan TL, Tang KW, Pak KK, Cheung JY: Screening for vestibular schwannoma by magnetic resonance imaging: analysis of 1821 patients. Hong Kong Med J. 2004;10:38-43.
Illes J, Kirschen MP, Edwards E, Stanford LR, Bandettini P, Cho MK et al. Ethics: incidental findings in brain imaging research. Science. 2006;311:783-4.
Fortnum H, O'Neill C, Taylor R, Lenthall R, Nikolopoulos T, Lightfoot G et al.: The role of magnetic resonance imaging in the identification of suspected acoustic neuroma: a systematic review of clinical and cost effectiveness and natural history. Health Technol Assess 2009, 13(18):iii-iv. ix-xi, 1- 154.
Sone M, Mizuno T, Naganawa S, Nakashima T: Imaging analysis in cases with inflammation-induced sensorineural hearing loss. Acta Otolaryngol. 2009;129:239-43.
Papanikolaou V, Khan M, Keogh I. Incidental findings on MRI scans of patients presenting with audiovestibular symptoms. BMC Ear, Nose and Throat Disorders. 2010, 10:6.
Saindane AM, Lim PP, Aiken A, Chen Z, Hudgins PA. Factors determining the clinical significance of an "empty" sella turcica. AJR Am J Roentgenol. 2013;200:1125-31.
Hoekstra CE, Prijs VF, Zanten GA. Diagnostic yield of a routine magnetic resonance imaging in tinnitus and clinical relevance of the anterior inferior cerebellar artery loops. Otol Neurotol. 2014;31:54-9.
Kalsotra P, Gupta R, Gupta N, Sharma R, Gupta S, Gupta GD. Incidental findings on magnetic resonance imaging in patients with tinnitus. Indian J Otol. 2015;21:41-6.
Scahill RI, Frost C, Jenkins R, Whitwell JL, Rossor MN, Fox NC: A longitudinal study of brain volume changes in normal aging using MRI. Arch Neurol. 2003;60:989-94.
Kerber KA, Enrietto JA, Jacobson KM, Baloh RW: Disequilibrium in older people: a prospective study. Neurology. 1998;51:574-80.
Kachewar SG, Kulkarni DS. a novel association of the additional intracranial calcification in lipoid proteinosis: a case report . J Clin Diagn Res. 2012;6:1579–81.
Kachewar SG, Gandage SG. The foetal ‘mind’ as a reflection of its inner self: evidence from colour doppler ultrasound of foetal MCA. Mens Sana Monogr. 2012;10:98-108.