В статье рассматривается дифференциальная диагностика острого вестибулярного синдрома. Представлены особенности сбора жалоб и анамнеза, основные клинические и инструментальные методы исследования. Приведены основные подходы к терапии таких заболеваний, проявляющихся острым головокружением, как вестибулярный нейронит, доброкачественное пароксизмальное позиционное головокружение, болезнь Меньера, вестибулярная мигрень и др.
The differential diagnostics of acute vestibular syndrome is discussed in the following article. Features of collection of complaints and anamnesis, basic clinical and instrumental methods of research are presented as well. The main approaches to the therapy of such diseases, manifested by acute dizziness, such as vestibular neuronitis, benign paroxysmal positional vertigo, Meniere's disease, vestibular migraine, etc. are presented.
1. Newman-Toker DE, Hsieh YH, Camargo CA et al. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc 2008; 83 (7): 765–75. DOI: 10.4065/83.7.765.
2. Brandt T, Dieterich M, Strupp M. Vertigo and dizziness – common complaints. 2nd edition. London: Springer, 2013.
3. Jeong SH, Kim HJ, Kim JS. Vestibular neuritis. Semin Neurol 2013; 33 (3): 185–94. DOI: 10.1055/s-0033-1354598.
4. Greco A, Macri GF, Gallo A et al. Is vestibular neuritis an immune related vestibular neuropathy inducing vertigo? J Immunol Res 2014; 2014: 459048. DOI: 10.1155/2014/459048.
5. Замерград М.В. Вестибулярный нейронит. РМЖ. 2008; 16 (12): 1630–2. / Zamergrad M.V. Vestibuliarnyi neironit. RMZh. 2008; 16 (12): 1630–2. [in Russian]
6. Leishman AW. Epidemic vertigo with oculomotor complication. Lancet 1955; 268 (6857): 228–30.
7. 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.
8. 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 (2): 273–4.
9. Strupp M, Magnusson M. Acute unilateral vestibulopathy. Neurol Clin 2015; 33 (3): 669–85. DOI: 10.1016/j.ncl.2015.04.012.
10. Gianoli G, Goebel J, Mowry S, Poomipannit P. Anatomic differences in the lateral vestibular nerve channels and their implications in vestibular neuritis. Otol Neurotol 2005; 26 (3): 489–94.
11. Taylor RL, McGarvie LA, Reid N et al. Vestibular neuritis affects both superior and inferior vestibular nerves. Neurology 2016; 87 (16): 1704–12.
12. Gliddon CM, Darlington CL, Smith PF. GABAergic systems in the vestibular nucleus and their contribution to vestibular compensation. Prog Neurobiol 2005; 75 (1): 53–81.
13. Пальчун В.Т., Крюков А.И., Гусева А.Л., Чернов А.Л. Повышение эффективности диагностики нистагма при помощи модифицированных очков Френзеля. Вестн. оториноларингологии. 2016; 81 (6): 78–81. DOI: 10.17116/otorino201681678-81. / Pal'chun V.T., Kriukov A.I., Guseva A.L., Chernov A.L. Povyshenie effektivnosti diagnostiki nistagma pri pomoshchi modifitsirovannykh ochkov Frenzelia. Vestn. otorinolaringologii. 2016; 81 (6): 78–81. DOI: 10.17116/otorino201681678-81. [in Russian]
14. Alexander G. Die Ohrenkrankheiten im Kindesalter. In: Schlossmann A (ed) Handbuch der Kinderheilkunde. Leipzig, Verlag von F.C.W. Vogel, 1912.
15. Halmagyi GM, Weber KP, Curthoys IS. Vestibular function after acute vestibular neuritis. Restor Neurol Neurosci 2010; 28 (1): 37–46. DOI: 10.3233/RNN-2010-0533.
16. Roberts HN, McGuigan S, Infeld B et al. A video-oculographic study of acute vestibular syndromes. Acta Neurol Scand 2016; 134 (4): 258–64. DOI: 10.1111/ane.12536.
17. Lee YJ, Shin JE, Park MS et al. Comprehensive analysis of head-shaking nystagmus in patients with vestibular neuritis. Audiol Neurootol 2012; 17 (4): 228–34. DOI: 10.1159/000336958.
18. Лучихин Л.А., Кунельская Н.Л., Гусева А.Л. и др. Диагностическая значимость клинических методов исследования глазодвигательных реакций при головокружении. Вестн. оториноларингологии. 2015; 2: 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: 8–11. [in Russian]
19. 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.
20. Bojrab DI, Stockwell CW. Electronystagmography and rotation tests. In: Neurotology. R.K.Jackler, D.E.Brackmann (еds.). St.Louis, Baltimore, Boston: Mosby, 1994; p. 219–28.
21. 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.
22. Пальчун В.Т., Гусева А.Л., Байбакова Е.В., Макоева А.А. Вестибулярный нейронит. Consilium Medicum. 2017; 19 (2): 64–70. / Palchun V.T., Guseva A.L., Baybakova E.V., Makoyeva А.А. Vestibular neuritis. Consilium Medicum. 2017; 19 (2): 64–70. [in Russian]
23. 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.
24. McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev 2015; 1: CD005397. DOI: 10.1002/14651858.CD005397.pub4.
25. 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.
26. 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.
27. 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.
28. Kattah JC, Talkad AV, Wang DZ et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40 (11): 3504–10. DOI: 10.1161/STROKEAHA.109.551234.
29. Cherchi M, Hain TC. Migraine-associated vertigo.Otolaryngol Clin North Am 2011; 44 (2): 367–75. DOI: 10.1016/j.otc.2011.01.008.
30. Lempert T, Olesen J, Furman J et al. Vestibular migraine: diagnostic criteria. J Vestib Res 2012; 22 (4): 167–72. DOI: 10.3233/VES-2012-0453.
31. Headache Classification Committee of the International Headache Society (IHS) The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 2013; 33 (9): 629–808. DOI: 10.1177/0333102413485658.
32. Polensek SH, Tusa RJ. Nystagmus during attacks of vestibular migraine: an aid in diagnosis. Audiol Neurotol 2010; 15 (4): 241–6. DOI: 10.1159/000255440.
33. Neuhauser H, Radtke A, Von Brevern M, Lempert T. Zolmitriptan for treatment of migrainous vertigo: a pilot randomized placebo-controlled trial. Neurology 2003; 60 (5): 882–3. DOI: 10.1212/01.wnl.0000049476.40047.a3.
34. Furman JM, Marcus DA, Balaban CD. Rizatriptan reduces vestibular-induced motion sickness in migraineurs. J Headache Pain 2011; 12 (1): 81–8. DOI: 10.1007/s10194-010-0250-z.
35. Prakash S, Shah ND. Migrainous vertigo responsive to intravenous methylprednisolone: case reports. Headache 2009; 49 (8): 1235–9. DOI: 10.1111/j.1526-4610.2009.01474.x.
36. Sohn JH. Recent Advances in the Understanding of Vestibular Migraine. Behav Neurol 2016; 2016: 1801845. DOI: 10.1155/2016/1801845.
37. Иванова Т.А., Филатова Е.Г. Вестибулярная мигрень. Фарматека. 2015; 19 (312): 21–7. / Ivanova T.A., Filatova E.G. Vestibuliarnaia migren'. Farmateka. 2015; 19 (312): 21–7. [in Russian]
38. Von Brevern M. Benign paroxysmal positional vertigo. Semin Neurol 2013; 33 (3): 204–11. DOI: 10.1055/s-0033-1354590.
39. Ishiyama G, Ishiyama A, Kerber K, Baloh RW. Gentamicin ototoxicity: clinical features and the effect on the human vestibulo-ocular reflex. Acta Otolaryngol 2006; 126 (10): 1057–61.
40. Lopez-Escamez JA, Carey J, Chung WH et al. Diagnostic criteria for Menière's disease. Consensus document of the Bárány Society, the Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology (EAONO), the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Korean Balance Society. Acta Otorrinolaringol Esp 2016; 67 (1): 1–7. DOI: 10.1016/j.otorri.2015.05.005.
41. Ramos Alcocer R, Ledezma Rodríguez JG, Navas Romero A et al. Use of betahistine in the treatment of peripheral vertigo. Acta Otolaryngol 2015; 135 (12): 1205–11. DOI: 10.3109/00016489.2015.1072873.
42. Крюков А.И., Кунельская Н.Л., Гаров Е.В. и др. Болезнь Меньера. Клинические рекомендации. М.; СПб., 2014. / Kriukov A.I., Kunel'skaia N.L., Garov E.V. i dr. Bolezn' Men'era. Klinicheskie rekomendatsii. M.; SPb., 2014. [in Russian]
43. Lee H, Baloh RW. Sudden deafness in vertebrobasilar ischemia: clinical features, vascular topographical patterns and long-term outcome. J Neurol Sci 2005; 228: 99–104.
44. Grad A, Baloh RW. Vertigo of vascular origin. Clinical and electronystagmographic features in 84 cases. Arch Neurol 1989; 46: 281–4.
45. Schlieter M, Zoubaa S, Kress B et al. Hemorrhagic acoustic schwannoma: radiological and histopathological findings. J Neuroradiol 2005; 32: 210–2.
46. Voss O. Kinderheilk, Holden HB, Schuknecht MD. Distribution pattern of blood in the inner ear following spontaneous subarachnoid haemorrhage. J Laryngol Otol 1968; 82: 321–9.
47. Schuknecht HF, Igarashi M, Chasin WD. Inner ear hemorrhage in leukaemia. A case report. Laryngoscope 1965; 75: 662–8.
48. Whitehead RE, MacDonald CB, Melhem ER, McMahon L. Spontaneous labyrinthine hemorrhage in sickle cell disease. Am J Neuroradiol 1998; 19: 1437–40.
49. Shinohara S, Yamamoto E, Saiwai S et al. Clinical features of sudden hearing loss associated with a high signal in the labyrinth on unenhanced T1-weighted magnetic resonance imaging. Eur Arch Otorhinolaryngol 2000; 257 (9): 480–4.
________________________________________________
1. Newman-Toker DE, Hsieh YH, Camargo CA et al. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc 2008; 83 (7): 765–75. DOI: 10.4065/83.7.765.
2. Brandt T, Dieterich M, Strupp M. Vertigo and dizziness – common complaints. 2nd edition. London: Springer, 2013.
3. Jeong SH, Kim HJ, Kim JS. Vestibular neuritis. Semin Neurol 2013; 33 (3): 185–94. DOI: 10.1055/s-0033-1354598.
4. Greco A, Macri GF, Gallo A et al. Is vestibular neuritis an immune related vestibular neuropathy inducing vertigo? J Immunol Res 2014; 2014: 459048. DOI: 10.1155/2014/459048.
5. Zamergrad M.V. Vestibuliarnyi neironit. RMZh. 2008; 16 (12): 1630–2. [in Russian]
6. Leishman AW. Epidemic vertigo with oculomotor complication. Lancet 1955; 268 (6857): 228–30.
7. 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.
8. 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 (2): 273–4.
9. Strupp M, Magnusson M. Acute unilateral vestibulopathy. Neurol Clin 2015; 33 (3): 669–85. DOI: 10.1016/j.ncl.2015.04.012.
10. Gianoli G, Goebel J, Mowry S, Poomipannit P. Anatomic differences in the lateral vestibular nerve channels and their implications in vestibular neuritis. Otol Neurotol 2005; 26 (3): 489–94.
11. Taylor RL, McGarvie LA, Reid N et al. Vestibular neuritis affects both superior and inferior vestibular nerves. Neurology 2016; 87 (16): 1704–12.
12. Gliddon CM, Darlington CL, Smith PF. GABAergic systems in the vestibular nucleus and their contribution to vestibular compensation. Prog Neurobiol 2005; 75 (1): 53–81.
13. Pal'chun V.T., Kriukov A.I., Guseva A.L., Chernov A.L. Povyshenie effektivnosti diagnostiki nistagma pri pomoshchi modifitsirovannykh ochkov Frenzelia. Vestn. otorinolaringologii. 2016; 81 (6): 78–81. DOI: 10.17116/otorino201681678-81. [in Russian]
14. Alexander G. Die Ohrenkrankheiten im Kindesalter. In: Schlossmann A (ed) Handbuch der Kinderheilkunde. Leipzig, Verlag von F.C.W. Vogel, 1912.
15. Halmagyi GM, Weber KP, Curthoys IS. Vestibular function after acute vestibular neuritis. Restor Neurol Neurosci 2010; 28 (1): 37–46. DOI: 10.3233/RNN-2010-0533.
16. Roberts HN, McGuigan S, Infeld B et al. A video-oculographic study of acute vestibular syndromes. Acta Neurol Scand 2016; 134 (4): 258–64. DOI: 10.1111/ane.12536.
17. Lee YJ, Shin JE, Park MS et al. Comprehensive analysis of head-shaking nystagmus in patients with vestibular neuritis. Audiol Neurootol 2012; 17 (4): 228–34. DOI: 10.1159/000336958.
18. 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: 8–11. [in Russian]
19. 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.
20. Bojrab DI, Stockwell CW. Electronystagmography and rotation tests. In: Neurotology. R.K.Jackler, D.E.Brackmann (еds.). St.Louis, Baltimore, Boston: Mosby, 1994; p. 219–28.
21. 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.
22. Palchun V.T., Guseva A.L., Baybakova E.V., Makoyeva А.А. Vestibular neuritis. Consilium Medicum. 2017; 19 (2): 64–70. [in Russian]
23. 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.
24. McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev 2015; 1: CD005397. DOI: 10.1002/14651858.CD005397.pub4.
25. 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.
26. 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.
27. 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.
28. Kattah JC, Talkad AV, Wang DZ et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40 (11): 3504–10. DOI: 10.1161/STROKEAHA.109.551234.
29. Cherchi M, Hain TC. Migraine-associated vertigo.Otolaryngol Clin North Am 2011; 44 (2): 367–75. DOI: 10.1016/j.otc.2011.01.008.
30. Lempert T, Olesen J, Furman J et al. Vestibular migraine: diagnostic criteria. J Vestib Res 2012; 22 (4): 167–72. DOI: 10.3233/VES-2012-0453.
31. Headache Classification Committee of the International Headache Society (IHS) The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 2013; 33 (9): 629–808. DOI: 10.1177/0333102413485658.
32. Polensek SH, Tusa RJ. Nystagmus during attacks of vestibular migraine: an aid in diagnosis. Audiol Neurotol 2010; 15 (4): 241–6. DOI: 10.1159/000255440.
33. Neuhauser H, Radtke A, Von Brevern M, Lempert T. Zolmitriptan for treatment of migrainous vertigo: a pilot randomized placebo-controlled trial. Neurology 2003; 60 (5): 882–3. DOI: 10.1212/01.wnl.0000049476.40047.a3.
34. Furman JM, Marcus DA, Balaban CD. Rizatriptan reduces vestibular-induced motion sickness in migraineurs. J Headache Pain 2011; 12 (1): 81–8. DOI: 10.1007/s10194-010-0250-z.
35. Prakash S, Shah ND. Migrainous vertigo responsive to intravenous methylprednisolone: case reports. Headache 2009; 49 (8): 1235–9. DOI: 10.1111/j.1526-4610.2009.01474.x.
36. Sohn JH. Recent Advances in the Understanding of Vestibular Migraine. Behav Neurol 2016; 2016: 1801845. DOI: 10.1155/2016/1801845.
37. Ivanova T.A., Filatova E.G. Vestibuliarnaia migren'. Farmateka. 2015; 19 (312): 21–7. [in Russian]
38. Von Brevern M. Benign paroxysmal positional vertigo. Semin Neurol 2013; 33 (3): 204–11. DOI: 10.1055/s-0033-1354590.
39. Ishiyama G, Ishiyama A, Kerber K, Baloh RW. Gentamicin ototoxicity: clinical features and the effect on the human vestibulo-ocular reflex. Acta Otolaryngol 2006; 126 (10): 1057–61.
40. Lopez-Escamez JA, Carey J, Chung WH et al. Diagnostic criteria for Menière's disease. Consensus document of the Bárány Society, the Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology (EAONO), the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Korean Balance Society. Acta Otorrinolaringol Esp 2016; 67 (1): 1–7. DOI: 10.1016/j.otorri.2015.05.005.
41. Ramos Alcocer R, Ledezma Rodríguez JG, Navas Romero A et al. Use of betahistine in the treatment of peripheral vertigo. Acta Otolaryngol 2015; 135 (12): 1205–11. DOI: 10.3109/00016489.2015.1072873.
42. Kriukov A.I., Kunel'skaia N.L., Garov E.V. i dr. Bolezn' Men'era. Klinicheskie rekomendatsii. M.; SPb., 2014. [in Russian]
43. Lee H, Baloh RW. Sudden deafness in vertebrobasilar ischemia: clinical features, vascular topographical patterns and long-term outcome. J Neurol Sci 2005; 228: 99–104.
44. Grad A, Baloh RW. Vertigo of vascular origin. Clinical and electronystagmographic features in 84 cases. Arch Neurol 1989; 46: 281–4.
45. Schlieter M, Zoubaa S, Kress B et al. Hemorrhagic acoustic schwannoma: radiological and histopathological findings. J Neuroradiol 2005; 32: 210–2.
46. Voss O. Kinderheilk, Holden HB, Schuknecht MD. Distribution pattern of blood in the inner ear following spontaneous subarachnoid haemorrhage. J Laryngol Otol 1968; 82: 321–9.
47. Schuknecht HF, Igarashi M, Chasin WD. Inner ear hemorrhage in leukaemia. A case report. Laryngoscope 1965; 75: 662–8.
48. Whitehead RE, MacDonald CB, Melhem ER, McMahon L. Spontaneous labyrinthine hemorrhage in sickle cell disease. Am J Neuroradiol 1998; 19: 1437–40.
49. Shinohara S, Yamamoto E, Saiwai S et al. Clinical features of sudden hearing loss associated with a high signal in the labyrinth on unenhanced T1-weighted magnetic resonance imaging. Eur Arch Otorhinolaryngol 2000; 257 (9): 480–4.
Авторы
Н.Л.Кунельская*1,2, А.Л.Гусева2, Е.В.Байбакова1
1 ГБУЗ «Научно-исследовательский клинический институт оториноларингологии им. Л.И.Свержевского» Департамента здравоохранения г. Москвы. 117152, Россия, Москва, Загородное ш., д. 18а, стр. 2;
2 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1 *nlkun@mail.ru
________________________________________________
N.L.Kunelskaya*1,2, A.L.Guseva2, E.V.Baybakova1
1 Scientific Research Clinical Institute of Otorhinolaryngology L.I.Sverzhevsky Department of Health of Moscow. 117152, Russian Federation, Moscow, Zagorodnoe sh., d. 18a, str. 2;
2 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 *nlkun@mail.ru