[Diagnosis and treatment of vestibular syndromes]

[Demographic and epidemiological risk factors in patients with acute vestibular neuritis]

OBJECTIVE

Vestibular neuritis (VN) is one of the most common peripheral vestibular balance disorder. Demographic and other risk factors associated with VN are insufficiently published. Therefore, the aim of this study is to identify associated risk factors in patients with acute VN.

METHODS

This study evaluated all hospitalized VN cases between 2017-2019. Inclusion criteria was an otoneurologically confirmed diagnosis of acute VN. Patient data was compared with data of the German normal population (Robert Koch Institute, "Gesundheit in Deutschland aktuell").

RESULTS

168 patients (Ø 59.8 years) were included. Compared with the normal German population, the study population was significantly more likely to have preexisting cardiovascular diseases, and the male patients were significantly more likely to have arterial hypertension. No significant differences were measurable between the study population and the normal population for other secondary diseases. Leukocytosis was present in 23% on admission, and 9% of patients reported a history of VZV or HSV-1 disease.

DISCUSSION

Etiology and pathogenesis of VN are poorly understood. Inflammatory and vascular causes are discussed. In this study, patients had increased prevalence of cardiovascular disease compared with the normal population, but the study population had a higher average age. Currently, it is unclear what significance nonspecific elevated leukocyte values could have as a possible sign of VN triggered by an infection. Since the number of inpatient cases with VN is rising, prospective studies should be performed to get a better understanding of the pathogenesis of the disease.

[Acute vestibular syndrome in emergency departments : Clinical differentiation of peripheral and central vestibulopathy]

INTRODUCTION

The differentiation between central and peripheral vestibular disorders is difficult in some cases, especially during the clinical routine of an emergency department (ED) without otoneurological diagnostic equipment. This study evaluated the frequency of vestibular pseudoneuritis as distinguished from acute peripheral vestibular disorders in patients who were admitted to hospital with the suspicion of vestibular neuropathy (VN).

METHODS

This retrospective study analyzed the results of anamnestic and clinical examinations of 315 patients admitted to the emergency department and the inpatient otoneurological examination results as well as the imaging of morphological alterations. In the ED, the clinical examination by a neurologist and an otorhinolaryngologist resulted in the characteristic signs of peripheral VN but no further evidence of a neurological disorder. Patients without signs of a peripheral vestibular disorder in the otoneurological diagnostics subsequently underwent cerebral magnetic resonance imaging scans (cMRI).

RESULTS

Suspected isolated VN could be confirmed in 69% of the patients; however, in a further 29% of the patients neither the suspected isolated VN nor an ischemic pathology of the central nervous system as a cause of the vertigo could be confirmed. Additional cMRI scans revealed that 2% of patients suffered from an infarction of the mesencephalon, the pons, the medulla oblongata and the cerebellum.

CONCLUSION

In rare cases central cerebral disorders mimic the pattern of a peripheral vestibular disorder. Despite thorough history taking, neurological and otolaryngological clinical examinations, it is not always possible to distinguish central and peripheral vestibular disorders of patients in emergency care suffering from acute vertigo. Video oculography-assisted caloric testing and the video head impulse test are recommended to confirm a peripheral VN. In cases without confirmation of suspected NV in otoneurological diagnostics, infarction of the mesencephalon, brain stem and cerebellum should be excluded by diffusion-weighted cMRI.

[Statokinetic characteristics of vestibular dysfunction in patients with vascular compression of the cochleo-vestibular nerve]

AIM

To study the state of statokinetic stability in patients with recurrent vestibular dysfunction caused by the vascular compression of the cochlea-vestibular nerve.

MATERIAL AND METHODS

Authors examined 30 patients with recurrent vestibular dysfunction in which neuroimaging studies revealed the vessel adjacent to the cochlea-vestibular nerve. Statokinetic stability evaluation was selected as a neurophysiological indicator of the cochlea-vestibular nerve hyperactivity syndrome.

RESULTS AND CONCLUSION

The correlation of the statokinetic stability indicators with the functional tests used and the side of the vascular compression of the cochlea-vestibular nerve has demonstrated high sensitivity of the statokinetic function to the turning of the head to the side of the neurovascular interaction with the decrease in stability in 17 (77.3%), as well as the minor in 15 (68.2%) and marked in 7 (31,8%) cases worsening of the statokinetic function during optokinetic stimulation (p<0.05). High diagnostic value of computer stabilometry with biological feedback in the objectification of the vestibulovegetative syndrome and detection of latent vestibular dysfunction in the patients with proven vascular compression of the cochlea-vestibular nerve has been shown.