Вестибулярный нейронит – острое заболевание периферической вестибулярной системы, проявляющееся вращательным головокружением, тошнотой, рвотой, нарушением координации. В статье представлен обзор по эпидемиологии, диагностике, дифференциальной диагностике и лечению этого заболевания. Основными диагностическими критериями являются отсутствие снижения слуха и неврологической симптоматики, наличие периферического нистагма, положительного теста поворота головы. Лечение заключается в назначении вестибулярных супрессантов и кортикостероидов в острый период и проведении индивидуального курса вестибулярной реабилитации.
Ключевые слова: вестибулярный нейронит, периферическая вестибулопатия, тест поворота головы, нистагм.
________________________________________________
Vestibular neuritis is an acute unilateral peripheral vestibular disorder, manifestating with vertigo, nausea, vomiting and balance disorders. The epidemiology, diagnostic features, differential diagnosis, and treatment of vestibular neuritis are reviewed. The main clinical criteria are peripheral nystagmus and positive head thrust test, absence of neurological signs and hearing disorders.The treatment includes vestibular suppressants, corticosteroids and individual physical vestibular rehabilitation.
1. Ruttin B. Zur differentialdiagnose der labyrinth. Horenrverkrankugen Z Ohrenheilk 1909; 57: 327–31.
2. Dix MR, Hallpike CS. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Ann Otol Rhinol Laryngol 1952; 61 (4): 987–1016.
3. Sekitani T, Imate Y, Noguchi T et al. Vestibular neuronitis: epidemiological survey by questionnaire in Japan. Acta Otolaryngol (Stockh) Suppl 1993; 503: 9–12.
4. Adamec I, Krbot SM, Handzic J et al. Incidence, seasonality and comorbidity in vestibular neuritis. Neurol Sci 2015; 36: 91–5.
5. Brandt T, Dieterich M, Strupp M. Vertigo and dizziness – common complaints. 2ndedition. London: Springer, 2013.
6. Gioacchini FM, Alicandri-Ciufelli M, Kaleci S et al. Prevalence and diagnosis of vestibular disorders in children: a review. Int J Pediatr Otorhinolaryngol 2014; 78: 718–24.
7. Walford P. Vertigo and influenza. BMJ 1949; 1: 821–2.
8. Matsuo T. Vestibular neuronitis-serum and CSF virus antibody titer. Auris Nasus Larynx 1986; 13 (1): 11–34.
9. Arbusow V, Derfuss T, Held K et al. Latency of herpes simplex virus type-1 in human geniculate and vestibular ganglia is associated with infiltration of CD8+ T cells. J Med Virol 2010; 82 (n): 1917–20.
10. Arbusow V, Schulz P, Strupp M et al. Distribution of herpes simplex virus type 1 in human geniculate and vestibular ganglia: implications for vestibular neuritis. Ann Neurol 1999; 46 (3): 416–9.
11. Theil D, Derfuss T, Strupp M et al. Cranial nerve palsies: herpes simplex virus type 1 and varizella-zoster virus latency. Ann Neurol 2002; 51: 273–4.
12. Esaki S, Goshima F, Kimura H et al. Auditory and vestibular defects induced by experimental labyrinthitis following herpes simplex virus in mice. Acta Otolaryngol 2011; 131 (7): 684–91.
13. Brandt T, Dieterieh M, Strupp M. Vertigo and dizziness; common complaints. London: Springer, 2005.
14. Gianoli G, Goebel J, Mowry S et al. Anatomic differences in the lateral vestibular nerve channels and their implications in vestibular neuritis. Otol Neurotol 2005; 26: 489–94.
15. Fetter M, Dichgans J. Three-dimensional human VOR in acute vestibular lesions. Ann NY Acad Sci 1996; 781: 619–21.
16. Alexander G. Die Ohrenkrankheiten im Kindesalter. In: Schlossmann A (ed) Handbuch der Kinderheilkunde. Leipzig: Verlag von F.C.W.Vogel, 1912.
17. Zwergal A, Rettinger N, Frenzel C et al. A bucket of static vestibular function. Neurology 2009; 72 (19): 1689–92. DOI: 10.1212/WNL.0b013e3181a55ecf
18. Mandalà M, Nuti D, Broman AT, Zee DS. Effectiveness of careful bedside examination in assessment, diagnosis, and prognosis of vestibular neuritis. Arch Otolaryngol Head Neck Surg 2008; 134 (2): 164–9. DOI: 10.1001/archoto.2007.35
19. Лучихин Л.А., Кунельская Н.Л., Гусева А.Л. и др. Диагностическая значимость клинических методов исследования глазодвигательных реакций при головокружении. Вестн. оториноларингологии. 2015; 2 (80): 8–11. / Luchikhin L.A., Kunel'skaia N.L., Guseva A.L. i dr. Diagnosticheskaia znachimost' klinicheskikh metodov issledovaniia glazodvigatel'nykh reaktsii pri golovokruzhenii. Vestn. otorinolaringologii. 2015; 2 (80): 8–11. [in Russian]
20. Jongkees LB, Maas J, Philipszoon A. Clinical electronystagmography: a detailed study of electronystagmography in 341 patients with vertigo. Pract Otorhinolaryngol (Basel) 1962; 24: 65–93.
21. Yang CJ, Lee JY, Kang BC et al. Quantitative analysis of gains and catch-up saccades of video-head impulse testing by age in normal subjects. Clin Otolaryngol 2015. DOI: 10.1111/coa.12558
22. Mossman B, Mossman S, Purdie G, Schneider E. Age dependent normal horizontal VOR gain of head impulse test as measured with video-oculography. J Otolaryngol Head Neck Surg 2015; 44: 29. DOI: 10.1186/s40463-015-0081-7
23. Adamec I, Skorić MK, Handžić J et al. The role of cervical and ocular vestibular-evoked myogenic potentials in the follow-up of vestibular neuritis. Clin EEG Neurosci 2014; 45 (2): 129–36. DOI: 10.1177/1550059413483452
24. Park HK, Kim JS, Strupp M, Zee DS. Isolated floccular infarction: impaired vestibular responses to horizontal head impulse. J Neurol 2013; 260 (6): 1576–82. DOI: 10.1007/s00415-013-6837-y
25. Thömke F, Hopf HC. Pontine lesions mimicking acute peripheral vestibulopathy. J Neurol Neurosurg Psychiatry 1999; 66 (3): 340–9.
26. Парфенов В.А., Абдулина О.В., Замерград М.В. Дифференциальный диагноз, прогноз и лечение острого вестибулярного головокружения. Неврол. журн. 2007; 12 (6): 21–5. / Parfenov V.A., Abdulina O.V., Zamergrad M.V. Differentsial'nyi diagnoz, prognoz i lechenie ostrogo vestibuliarnogo golovokruzheniia. Nevrol. zhurn. 2007; 12 (6): 21–5. [in Russian]
27. Newman-Toker DE, Curthoys IS, Halmagyi GM. Diagnosing Stroke in Acute Vertigo: The HINTS Family of Eye Movement Tests and the Future of the "Eye ECG".Semin Neurol 2015; 35 (5): 506–21. DOI: 10.1055/s-0035-1564298
28. Asprella-Libonati G. Lateral canal BPPV with Pseudo-Spontaneous Nystagmus masquerading as vestibular neuritis in acute vertigo: a series of 273 cases. J Vestib Res 2014; 24 (5–6): 343–9. DOI: 10.3233/VES-140532
29. Кунельская Н.Л., Байбакова Е.В., Янюшкина Е.С. и др. Ранняя диагностика акустической шванномы. Вестн. оториноларингологии. 2015; 80 (4): 85–7. / Kunel'skaia N.L., Baibakova E.V., Ianiushkina E.S. i dr. Ranniaia diagnostika akusticheskoi shvannomy. Vestn. otorinolaringologii. 2015; 80 (4): 85–7. [in Russian]
30. Walker MF. Treatment of vestibular neuritis. Curr Treat Options Neurol 2009; 11 (1): 41–5.
31. Strupp M, Zingler VC, Arbusow V et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med 2004; 351 (4): 354–61.
32. Shupak A, Issa A, Golz A et al. Prednisone treatment for vestibular neuritis. Otol Neurotol 2008; 29 (3): 368–74. DOI: 10.1097/MAO.0b013e3181692804
33. Fishman JM, Burgess C, Waddell A. Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Database Syst Rev 2011; 5: CD008607. DOI: 10.1002/14651858.CD008607.pub2
34. Hall CD, Herdman SJ, Whitney SL et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: from the American Physical Therapy Association Neurology Section. J Neurol Phys Ther 2016; 40 (2): 124–55. DOI: 10.1097/NPT.0000000000000120
35. McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev 2015; 1: CD005397. DOI: 10.1002/14651858.CD005397.pub4
36. Herdman SJ Vestibular rehabilitation. Curr Opin Neurol 2013; 26 (1): 96–101. DOI: 10.1097/WCO.0b013e32835c5ec4
37. Naguib MB, Madian YT. Betahistine dihydrochloride with and without early vestibular rehabilitation for the management of patients with balance disorders following head trauma: a preliminary randomized clinical trial. J Chiropr Med 2014; 13 (1): 14–20. DOI: 10.1016/j.jcm.2014.01.011
38. Karapolat H, Celebisoy N, Kirazli Y et al. Does betahistine treatment have additional benefits to vestibular rehabilitation? Eur Arch Otorhinolaryngol 2010; 267 (8): 1207–12. DOI: 10.1007/s00405-010-1216-0
39. Botta L, Mira E, Valli S et al. Effects of betahistine and of its metabolites on vestibular sensory organs. Acta Otorhinolaryngol Ital 2001; 21 (3 Suppl. 66): 24–30.
40. Günther L, Beck R, Xiong G et al. N-acetyl-L-leucine accelerates vestibular compensation after unilateral labyrinthectomy by action in the cerebellum and thalamus. PLoS One 2015; 10 (3): e0120891. DOI: 10.1371/journal.pone.0120891
41. Baloh RW. Clinical practice. Vestibular neuritis. N Engl J Med 2003; 348 (11): 1027–32.
42. Huppert D, Strupp M, Theil D et al. Low recurrence rate of vestibular neuritis: a long-term follow-up. Neurology 2006; 67 (10): 1870–1.
43. Kim YH, Kim KS, Kim KJ et al. Recurrence of vertigo in patients with vestibular neuritis. Acta Otolaryngol 2011; 131: 1172–7.
44. Balatsouras DG, Koukoutsis G, Ganelis P et al. Benign paroxysmal positional vertigo secondary to vestibular neuritis. Eur Arch Otorhinolaryngol 2014; 271 (5): 919–24. DOI: 10.1007/s00405-013-2484-2
45. Godemann F, Schuller J, Uhlemann H et al. Psychodynamic vulnerability factors in the development of panic disorders--a prospective trial in patients after vestibular neuritis. 45. Psychopathology 2009; 42 (2): 99–107. DOI: 10.1159/000203342
________________________________________________
1. Ruttin B. Zur differentialdiagnose der labyrinth. Horenrverkrankugen Z Ohrenheilk 1909; 57: 327–31.
2. Dix MR, Hallpike CS. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Ann Otol Rhinol Laryngol 1952; 61 (4): 987–1016.
3. Sekitani T, Imate Y, Noguchi T et al. Vestibular neuronitis: epidemiological survey by questionnaire in Japan. Acta Otolaryngol (Stockh) Suppl 1993; 503: 9–12.
4. Adamec I, Krbot SM, Handzic J et al. Incidence, seasonality and comorbidity in vestibular neuritis. Neurol Sci 2015; 36: 91–5.
5. Brandt T, Dieterich M, Strupp M. Vertigo and dizziness – common complaints. 2ndedition. London: Springer, 2013.
6. Gioacchini FM, Alicandri-Ciufelli M, Kaleci S et al. Prevalence and diagnosis of vestibular disorders in children: a review. Int J Pediatr Otorhinolaryngol 2014; 78: 718–24.
7. Walford P. Vertigo and influenza. BMJ 1949; 1: 821–2.
8. Matsuo T. Vestibular neuronitis-serum and CSF virus antibody titer. Auris Nasus Larynx 1986; 13 (1): 11–34.
9. Arbusow V, Derfuss T, Held K et al. Latency of herpes simplex virus type-1 in human geniculate and vestibular ganglia is associated with infiltration of CD8+ T cells. J Med Virol 2010; 82 (n): 1917–20.
10. Arbusow V, Schulz P, Strupp M et al. Distribution of herpes simplex virus type 1 in human geniculate and vestibular ganglia: implications for vestibular neuritis. Ann Neurol 1999; 46 (3): 416–9.
11. Theil D, Derfuss T, Strupp M et al. Cranial nerve palsies: herpes simplex virus type 1 and varizella-zoster virus latency. Ann Neurol 2002; 51: 273–4.
12. Esaki S, Goshima F, Kimura H et al. Auditory and vestibular defects induced by experimental labyrinthitis following herpes simplex virus in mice. Acta Otolaryngol 2011; 131 (7): 684–91.
13. Brandt T, Dieterieh M, Strupp M. Vertigo and dizziness; common complaints. London: Springer, 2005.
14. Gianoli G, Goebel J, Mowry S et al. Anatomic differences in the lateral vestibular nerve channels and their implications in vestibular neuritis. Otol Neurotol 2005; 26: 489–94.
15. Fetter M, Dichgans J. Three-dimensional human VOR in acute vestibular lesions. Ann NY Acad Sci 1996; 781: 619–21.
16. Alexander G. Die Ohrenkrankheiten im Kindesalter. In: Schlossmann A (ed) Handbuch der Kinderheilkunde. Leipzig: Verlag von F.C.W.Vogel, 1912.
17. Zwergal A, Rettinger N, Frenzel C et al. A bucket of static vestibular function. Neurology 2009; 72 (19): 1689–92. DOI: 10.1212/WNL.0b013e3181a55ecf
18. Mandalà M, Nuti D, Broman AT, Zee DS. Effectiveness of careful bedside examination in assessment, diagnosis, and prognosis of vestibular neuritis. Arch Otolaryngol Head Neck Surg 2008; 134 (2): 164–9. DOI: 10.1001/archoto.2007.35
19. Luchikhin L.A., Kunel'skaia N.L., Guseva A.L. i dr. Diagnosticheskaia znachimost' klinicheskikh metodov issledovaniia glazodvigatel'nykh reaktsii pri golovokruzhenii. Vestn. otorinolaringologii. 2015; 2 (80): 8–11. [in Russian]
20. Jongkees LB, Maas J, Philipszoon A. Clinical electronystagmography: a detailed study of electronystagmography in 341 patients with vertigo. Pract Otorhinolaryngol (Basel) 1962; 24: 65–93.
21. Yang CJ, Lee JY, Kang BC et al. Quantitative analysis of gains and catch-up saccades of video-head impulse testing by age in normal subjects. Clin Otolaryngol 2015. DOI: 10.1111/coa.12558
22. Mossman B, Mossman S, Purdie G, Schneider E. Age dependent normal horizontal VOR gain of head impulse test as measured with video-oculography. J Otolaryngol Head Neck Surg 2015; 44: 29. DOI: 10.1186/s40463-015-0081-7
23. Adamec I, Skorić MK, Handžić J et al. The role of cervical and ocular vestibular-evoked myogenic potentials in the follow-up of vestibular neuritis. Clin EEG Neurosci 2014; 45 (2): 129–36. DOI: 10.1177/1550059413483452
24. Park HK, Kim JS, Strupp M, Zee DS. Isolated floccular infarction: impaired vestibular responses to horizontal head impulse. J Neurol 2013; 260 (6): 1576–82. DOI: 10.1007/s00415-013-6837-y
25. Thömke F, Hopf HC. Pontine lesions mimicking acute peripheral vestibulopathy. J Neurol Neurosurg Psychiatry 1999; 66 (3): 340–9.
26. Parfenov V.A., Abdulina O.V., Zamergrad M.V. Differentsial'nyi diagnoz, prognoz i lechenie ostrogo vestibuliarnogo golovokruzheniia. Nevrol. zhurn. 2007; 12 (6): 21–5. [in Russian]
27. Newman-Toker DE, Curthoys IS, Halmagyi GM. Diagnosing Stroke in Acute Vertigo: The HINTS Family of Eye Movement Tests and the Future of the "Eye ECG".Semin Neurol 2015; 35 (5): 506–21. DOI: 10.1055/s-0035-1564298
28. Asprella-Libonati G. Lateral canal BPPV with Pseudo-Spontaneous Nystagmus masquerading as vestibular neuritis in acute vertigo: a series of 273 cases. J Vestib Res 2014; 24 (5–6): 343–9. DOI: 10.3233/VES-140532
29. Kunel'skaia N.L., Baibakova E.V., Ianiushkina E.S. i dr. Ranniaia diagnostika akusticheskoi shvannomy. Vestn. otorinolaringologii. 2015; 80 (4): 85–7. [in Russian]
30. Walker MF. Treatment of vestibular neuritis. Curr Treat Options Neurol 2009; 11 (1): 41–5.
31. Strupp M, Zingler VC, Arbusow V et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med 2004; 351 (4): 354–61.
32. Shupak A, Issa A, Golz A et al. Prednisone treatment for vestibular neuritis. Otol Neurotol 2008; 29 (3): 368–74. DOI: 10.1097/MAO.0b013e3181692804
33. Fishman JM, Burgess C, Waddell A. Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Database Syst Rev 2011; 5: CD008607. DOI: 10.1002/14651858.CD008607.pub2
34. Hall CD, Herdman SJ, Whitney SL et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: from the American Physical Therapy Association Neurology Section. J Neurol Phys Ther 2016; 40 (2): 124–55. DOI: 10.1097/NPT.0000000000000120
35. McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev 2015; 1: CD005397. DOI: 10.1002/14651858.CD005397.pub4
36. Herdman SJ Vestibular rehabilitation. Curr Opin Neurol 2013; 26 (1): 96–101. DOI: 10.1097/WCO.0b013e32835c5ec4
37. Naguib MB, Madian YT. Betahistine dihydrochloride with and without early vestibular rehabilitation for the management of patients with balance disorders following head trauma: a preliminary randomized clinical trial. J Chiropr Med 2014; 13 (1): 14–20. DOI: 10.1016/j.jcm.2014.01.011
38. Karapolat H, Celebisoy N, Kirazli Y et al. Does betahistine treatment have additional benefits to vestibular rehabilitation? Eur Arch Otorhinolaryngol 2010; 267 (8): 1207–12. DOI: 10.1007/s00405-010-1216-0
39. Botta L, Mira E, Valli S et al. Effects of betahistine and of its metabolites on vestibular sensory organs. Acta Otorhinolaryngol Ital 2001; 21 (3 Suppl. 66): 24–30.
40. Günther L, Beck R, Xiong G et al. N-acetyl-L-leucine accelerates vestibular compensation after unilateral labyrinthectomy by action in the cerebellum and thalamus. PLoS One 2015; 10 (3): e0120891. DOI: 10.1371/journal.pone.0120891
41. Baloh RW. Clinical practice. Vestibular neuritis. N Engl J Med 2003; 348 (11): 1027–32.
42. Huppert D, Strupp M, Theil D et al. Low recurrence rate of vestibular neuritis: a long-term follow-up. Neurology 2006; 67 (10): 1870–1.
43. Kim YH, Kim KS, Kim KJ et al. Recurrence of vertigo in patients with vestibular neuritis. Acta Otolaryngol 2011; 131: 1172–7.
44. Balatsouras DG, Koukoutsis G, Ganelis P et al. Benign paroxysmal positional vertigo secondary to vestibular neuritis. Eur Arch Otorhinolaryngol 2014; 271 (5): 919–24. DOI: 10.1007/s00405-013-2484-2
45. Godemann F, Schuller J, Uhlemann H et al. Psychodynamic vulnerability factors in the development of panic disorders--a prospective trial in patients after vestibular neuritis. 45. Psychopathology 2009; 42 (2): 99–107. DOI: 10.1159/000203342
1 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1;
2 ГБУЗ «Научно-исследовательский клинический институт оториноларингологии им. Л.И.Свержевского» Департамента здравоохранения г. Москвы. 117152, Россия, Москва, Загородное ш., д. 18А, стр. 2 *lorrsmu@mail.ru
1 N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1;
2 L.I.Sverzhevskii Research and Clinical Institute of Otorhinolaryngology. 117152, Russian Federation, Moscow, Zagorodnoe sh., d. 18A, str. 2 *lorrsmu@mail.ru