Vertigo that may be caused by a viral infection? Pay attention to the choice of treatment plan...

Have you seen patients with acute onset of persistent vertigo, nausea, and gait disturbance as the main symptoms, which can be accompanied by vibratory hallucinations and dumping, often lasting from 24 hours to weeks? After excluding posterior circulation infarction, sudden deafness with vertigo, and other peripheral vertigo diseases, the diagnosis of "vestibular neuritis" (VN) is one of the common peripheral acute vestibular syndromes, which is a benign, self-limited disease
.

There are few epidemiological data on VN, but several clinical data show that VN has the third highest incidence of peripheral vestibular disease, after benign paroxysmal positional vertigo and Meniere's disease
.
In a statistical study of patients with dizziness in the emergency department in the United States, at least 6% of patients were diagnosed with VN^[1].

It accounts for a significant proportion of diseases that cause vertigo
.

At present, the etiology of VN is not completely clear, it is generally believed that VN is an inflammatory disease that selectively invades the vestibular branch of the eighth cranial nerve ^[2], and more and more studies support its pathogenesis related to viral infection, and some scholars have proposed vascular etiology and autoimmune etiology
.
When the vestibular nerve is damaged, the acceleration and deceleration movement signals and balance signals from the semicircular canal, balloon and elliptical sac cannot be transmitted normally, and clinical symptoms such as vertigo, nystagmus, and posture instability will occur
.

Based on the current research results at home and abroad and the clinical experience of experts, and referring to the 2020 "Multidisciplinary Expert Consensus on the Diagnosis and Treatment of Vestibular Neuritis" ^[3], the recommended treatment principles of VN are acute symptomatic treatment, glucocorticoid therapy and early vestibular rehabilitation
。 In clinical practice, unless there is clear evidence of viral infection can use antiviral drugs such as valacyclovir, conventional antiviral therapy is generally not recommended for VN patients, VN drug treatment regimens include vestibular inhibitors, glucocorticoids, vestibular compensation drugs, etc.
, in addition to drug treatment, vestibular rehabilitation treatment (VRT), patient education is also an effective treatment
.

To learn more about vestibular neuritis, please click the figure below to enter the diagnosis and treatment knowledge base product of Yimaitong - "Medical Knowledge Source Disease Knowledge Base"
.
The knowledge of vestibular neuritis written by Dr.
Yu Hong of the First Hospital of Jilin University comprehensively shows the etiology, epidemiology, diagnosis and treatment process, diagnostic criteria, treatment rules and drug treatment plan
of vestibular neuritis.

• Check the diagnosis and treatment plan, how "6" is "Medical Knowledge Source"? Immerse yourself in it

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References:

[1] Tarnutzer AA, Berkowitz AL, Robinson KA, et al.
Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome[J].
 CMAJ,  2011, 183(9): E571-92.
DOI: 10.
1503/cmaj.
100174 .

[2] Byun H, Chung JH, Lee SH, et al.
Clinical value of 4- hour delayed gadolinium-enhanced 3D FLAIR MR images in acute vestibular neuritis[J].
Laryngoscope, 2018, 128(8): 1946-1951.
 DOI: 10.
1002/lary.
27084.

LI Fei, JU Yi, ZHANG Sulin, et al.
Multidisciplinary expert consensus on the diagnosis and treatment of vestibular neuritis[J].
Chinese Journal of Geriatrics, 2020, 39(09): 985-994.
DOI: 10.
3760/cma.
j.
issn.
0254-9026.
2020.
09.
001.