Tontura e vertigem no idoso: diagnóstico diferencial prático

Abstract

Dizziness and vertigo in older adults are common, multifactorial complaints with significant impact on functionality and quality of life. Causes include peripheral vestibular disorders, central neurological conditions, cardiovascular alterations, drug effects, and psychogenic factors. This study, based on a narrative literature review and clinical guidelines, identifies benign paroxysmal positional vertigo as the most prevalent cause, with effective diagnosis through the Dix-Hallpike maneuver and treatment via the Epley maneuver. Central causes, such as stroke, and systemic ones like orthostatic hypotension and polypharmacy, were also relevant. Anxiety and depression were associated with symptom aggravation. A structured and interdisciplinary diagnostic approach showed better therapeutic outcomes. Detailed history, focused physical examination, and selective use of complementary exams are essential for effective differential diagnosis. Vestibular rehabilitation, medication review, and psychosocial support are key strategies for clinical improvement. Training in geriatric otoneurology and the use of practical clinical protocols can optimize patient management.