Abordaje de la neuritis vestibular en el Hospital Universitario de Burgos (HUBU)

Abstract

Introduction and objective: Vestibular neuritis is an unknown etiology entity. Viral origin is the most accepted. Anual incidence is 3-15 cases per 100.000 habitants. Diagnosis is based on clinical features and physical exploration, but differential diagnosis with central patology is essential. It has been demonstrated a faster recovery of canalicular paresy with the administration of systemic corticoids and central compensation improvement with vestibular rehabilitation. HUBU Otoneurology section has used the following protocol for diagnosis and treatment of patients with vestibular neuritis since 2018. Method: For diagnosis we have based on acute unilateral vestibulopathy criteria of Vestibular Disorders International Classification. As complementary studies we use horizontal plane recorded with video-Head Impulse Test and craneal MRI. All patients, excepting contraindications, receive systemic corticoids (mg/Kg 10 days) and Cawthorne and Cooksey exercises. In cases there is no improvement, an individual hospital vestibular rehabilitation is programmed. Monitoring is made with new anamnesis, physical exploration and HIT study in 1 month, 4 and 10 months from diagnosis. We have made a retrospective study of vestibular neuritis diagnosticated patients in the last 4 years. Parameters included are: age, sex, affected side, nystagmus, clinical syntoms, vestibulo-ocular reflex gains and saccades in HIT study, MRI results, CVRF, previous infection, hospital admission. Results: We reviewed 58 patients with vestibular neuritis diagnosis from 2018 to 2021. 7 have been excluded because of incomplete follow-up. 51 were monitored for 10 months (23 women and 28 men). In 25.5% of patients, nystagmus dissapeared in the first month; 31.4% in the fourth; 35.3% in the tenth, and persisted in 7.8%. In HIT study gains normalized in 33.3% of patients in the first month, 15.7% in the fourth, and 31.4% in the tenth, persisting in 19.6%. Clinical syntoms dissapeared in 19.6% in the first month; 33.3% in the fourth; 39.2% in the tenth, and persisted in 7.9% beyond ten months. 15 patients needed hospital vestibular rehabilitation with dynamic posturography and floor exercises, all of them experimenting a great clinical improvement. MRI was made in 42 patients, being normal in all of them. 37.3% of the cases presented cardiovascular risk factors. 9.8% related respiratory/gastrointestinal infection antecedent previous to vestibular debut. Lastly, 33 of 51 patients needed hospital admission, while 18 received domiciliary treatment. Discussion/Conclusions: 41 patients presented a complete recovery of vestibular function during follow-up. In 47 clinical syntoms dissapeared, recovering their previous life quality. In 10 patients a vestibular hypofunction persisted, all of them were rehabilitated, with relevant clinical improvement. Recently it has been demonstrated that central compensation is significantly better in patients who made an early hospital rehabilitation. That make us reconsider if we are selecting properly the moment when this is initiated.