Vestibular neuronitis: causes, symptoms, principles of diagnosis and treatment

Vestibular neuronitis (acute peripheral vestibulopathy) is a sudden disease of the vestibular apparatus, which is not dangerous to human life. The main symptoms are acute dizziness with nausea and vomiting, the inability to move independently due to instability. When such symptoms appear to a person, of course, it becomes scary, and he first rushes for medical help. In addition to vestibular neuronitis, a similar clinical picture is observed with a number of other neurological and significantly more dangerous diseases. Only a competent specialist can distinguish them, and sometimes additional research methods are needed for this. So, let's try to figure out what this pathology is, the "vestibular neuronitis", because of what it appears, what is characterized, how it is diagnosed and how it is treated. All this is devoted to this article.

Vestibular neuronitis is a disease with a decent experience, after all, it has already crossed the age-old boundary. For the first time, his symptoms became known to the world back in 1909 thanks to Eric Ruttin. But the medical community became available only in 40 years - in 1949, when the American otorhinolaryngologist Charles Hallpike proposed the term "vestibular neuronitis" and gave a detailed description of the symptoms of the disease.

Among all known causes of so-called vestibular vertigo, acute peripheral vestibulopathy is located on the third place after benign paroxysmal positional vertigo (DPPG) and Meniere's disease, that is, it occurs quite often. The disease equally "loves" both men and women, preferring young and middle age (30-60 years), although there are exceptions to this rule.

Causes

The source of the disease, presumably, is the selective inflammatory process of the vestibular nerve (the 8th pair of cranial nerves). Selective, because the other nerve fibers of the body remain intact, which remains unclear until today. What causes inflammation of the vestibular nerve? It can be:

• any viruses (especially herpes simplex virus type 1);
• food poisoning (toxicinfections);
• infectious-allergic diseases;
• metabolic disorders.

The role of viruses in the onset of vestibular neuronitis is practically undeniable at the present time. The fact is that often the symptoms of the disease occur in a week or two after suffering an acute respiratory illness. In addition, vestibular neuronitis is characterized by an epidemic surge in incidence at the end of spring. The cases of occurrence of disease among members of one family with a small interval of time are described.
On the herpetic nature of the disease began talking, when there were descriptions of cases of herpetic encephalitis after the onset of vestibular neuronitis.

Sometimes the cause of the development of the disease remains unknown, which indicates that the nature of the vestibular neuronite has not been fully established.

Symptoms

Most often, the vestibular neuronitis appears suddenly against a background of seemingly full well-being. The patient has a sharp dizziness, because of which he may even fall. Vertigo is truly vestibular, which is associated with the defeat of the vestibular nerve itself, characterized by sensation rotation of one's own body in space, rotation of objects around, failing or throwing up. Sometimes patients describe their feelings in the following way: "I was sent without warning to the cosmos!" Dizziness lasts from several hours to several days, with a tendency to gradually decrease. Symptoms are aggravated by movements of the head and bends of the trunk. But when fixing a glance at one point, dizziness decreases. A few hours or days before the occurrence of such prolonged dizziness, patients may experience short-term feelings of failure or rotation, which are less intense than the main attack.

In addition to dizziness, an attack of vestibular neuronitis is characterized by:

• nausea and vomiting;
• violation of equilibrium. Initially, the patient can not move at all, and then for some time the instability persists while walking, so additional support is needed. The disorder of coordination is characteristic not only for the lower extremities, but also for the upper limbs. Movements become inaccurate, missishable, awkward, which can manifest difficulties in eating, writing, buttoning up buttons, lacing shoes and so on;
• nystagmus. Nystagmus is an involuntary vibrational movement of the eyes. With vestibular neuronite, nystagmus is directed in one direction - into a healthy one (if one nerve, right or left) is affected. With bilateral vestibular neuronitis, which is extremely rare, nystagmus will be bilateral. The duration of the nystagmus can fluctuate. Spontaneous nystagmus usually lasts several days, provoked by a look in the healthy side - up to 3 weeks. Sometimes it may seem that the nystagmus has already disappeared, but a study in Frenzel's special glasses makes it possible to detect it;
• an instability in the Romberg pose. If the patient is placed in an upright position, the legs are together, the arms are extended forward to the horizontal palms down, eyes closed, then the patient can not hold such a position on his own. Most likely the patient will deviate (fall) towards the affected nerve. As the symptoms of vestibular neuronitis decrease, stability in Romberg's posture returns, but if you put the patient in a complicated Romberg pose (when one leg is exposed in front of the other in a straight line, and the heel in front of the standing leg touches the toe of the rear leg), then the deviation to the affected side will still be preserved.

Since the vestibular neuron is affected only by the vestibular nerve, there is never a change in hearing. This feature of the disease is an important diagnostic moment. With other pathologies of the nervous system and the vestibular apparatus, hearing loss and the appearance of additional symptoms are possible. Vestibular neuronitis is never accompanied by additional focal symptomatology, since all other structures of the nervous system do not suffer.

Pronounced dizziness with nausea and vomiting usually lasts from several hours to several days. Then gradually the patient becomes lighter. Approximately about two weeks, there is still dizziness, sometimes nausea. Then for some time the patient feels some instability and unsteadiness while walking. If all the symptoms go away within 6 months, then the vestibular neuronitis is considered acute, but if they continue to persist, then they talk about the chronic course.

The timing of recovery of health in the vestibular neuronite is very variable. This depends on the completeness of the treatment received, and on the individual sensitivity to the drugs of the individual patient, and on the stability of the vestibular system as a whole.

Very rarely (approximately 2% of cases) a relapse of the disease is possible. In such cases, the second, "healthy" side is affected.

Diagnostics

Before appointing a caloric test, the doctor conducts an otoscopy to exclude possible contraindications to it (perforation of the tympanic membrane).

Vestibular neuronitis refers to difficult to diagnose diseases. To establish such a diagnosis requires a careful collection of medical history (including information on diseases that preceded the symptoms vestibular neuronitis), careful examination of the patient, as well as a number of additional methods of research.

In favor of the vestibular neuronitis, the data are:

• communication with a recent viral infection;
• absence of additional symptoms in the form of hearing impairment, headache, weakness in the limbs, speech disorders and the like;
• duration of dizziness from several hours to several days without increasing symptoms and further deterioration of the condition.

To confirm the diagnosis, conduct a caloric test. Its results indicate a unilateral lesion of the vestibular nerve (its upper part).

The modern method for diagnosing the lesion of the vestibular apparatus, including vestibular neuronitis, is caused by vestibular myogenic potentials. The method is completely painless and harmless, which is important.

With the vestibular neuronitis, magnetic resonance imaging of the brain can be performed. This is due to the need for differential diagnosis of the symptoms of vestibular neuronitis, for example, with cerebrovascular disorders in the vertebro-basilar system.

Treatment

The main direction in the treatment of vestibular neuronitis is symptomatic therapy. It consists in removing the main symptoms of the disease: dizziness, instability, nausea and vomiting. For this purpose, the following can be used:

• vestibular suppressants - blockers of H1-histamine receptors (Dramina, Dedalon, Ciel);
• histamine-like substances (Betagistin, Betaserk, Vestibo, Westinorm), which facilitate central vestibular compensation;
• antiemetic drugs (Metoclopramide or Cerucal, Osetron, Scopolamine (can be used as a patch gluing behind the ear);
• sedatives (tranquilizers): Gidazepam, Sibazon, Rudotel and others;
• diuretics (Furosemide, Lasix, Diacarb, Spironolactone), which reduce edema of nerve fibers.

Usually, the combined use of these drugs allows a few days to reduce the severity of the main symptoms of vestibular neuronitis. After the disappearance of nausea and vomiting, and dizziness is significantly reduced, proceed to a non-medicamental method of treatment - vestibular gymnastics.

Vestibular gymnastics consists in performing in a certain sequence of exercises with fixation of the look at objects under different angles, movements of the eyeballs, head and body. The essence of such gymnastics consists in the receipt in the brain of stimuli from various senses, which leads to a sensory mismatch, that is, as it were, provokes the resumption of dizziness. But at the same time, such actions are training, raising the threshold of vestibular apparatus excitability, which, ultimately, pursues the goal of vestibular compensation. The first time performing vestibular gymnastics may be accompanied by a subjective deterioration of the condition, however it is necessary to persistently continue the studies, overcoming unpleasant sensations, and the result will not take long to wait. The timing of the gymnastics depends on the individual sensitivity of the vestibular apparatus. Compensation comes in all different ways. The minimum duration of the vestibular exercise is 1 month. To accelerate the development of vestibular compensation, the use of betagistin (Betaserka, Vestibo, Vestinorma) 24 mg twice daily is prescribed with gymnastics.

Complete recovery of the vestibular function occurs in a year in 40% of patients, in 30% recovery is partial. The remaining 30% of patients fall into the category of patients with a one-sided violation of the vestibular apparatus, which persists further. However, when performing vestibular gymnastics, the processes of central compensation take precedence over the residual phenomena of the disease, and the patient does not experience significant problems with coordination and balance.

Thus, the vestibular neuronitis is a disease of the apparatus of balance and coordination of movements. Most often, the disease is a consequence of viral damage to the vestibular nerve. The main symptoms are acute dizziness with nausea and vomiting in the absence of hearing impairment. To eliminate the symptoms of the disease you need drugs and vestibular gymnastics, which allows you to "train" the vestibular apparatus and make it more resistant to irritants. The prognosis for recovery is favorable in most cases.