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The main symptom of vestibular neuronitis is a pronounced, acutely developing, paroxysmal, but prolonged systemic dizziness, which is usually accompanied by vomiting, imbalance. Often the development of symptoms is preceded by SARS.
Sometimes, some time before the full clinical picture, patients experience brief bouts of imbalance or dizziness. Symptoms of vestibular neuronitis increase during head movements or a change in body position in space. Some decrease in the severity of dizziness occurs when fixing the gaze on one point while maintaining a stationary position of the body. On examination, patients have a rather rough spontaneous nystagmus, while its fast phase will be strictly directed towards the diseased ear.
At the same time, the imaginary systemic rotation of diclofenac around the patient in the classical versions is directed towards the healthy ear.
When conducting a test (pose) of Romberg, the patient deviates towards the lesion. Hearing with neuronitis is not significantly reduced. At the same time, a neurological examination does not reveal focal symptoms of damage to the brain stem or other parts of the brain. The duration of diclofenac pills is noted from 2-3 hours to several days and, in rare cases, even up to a week. Spontaneous nystagmus can be observed for about 4 days, horizontal nystagmus when the eyes follow the object towards the healthy ear when wearing Frenzel glasses (fixation of the gaze is turned off) is observed up to 3 weeks. After the vertigo attack stops, the patient may experience balance and gait disturbance for some time.
Video about vestibular neuronitis.
The criteria for diagnosing vestibular neuronitis are the presence of characteristic symptoms: acute, paroxysmal and prolonged (more than 3 hours) systemic dizziness, which is accompanied by nausea and / or vomiting, as well as instability;nystagmus in the direction of the lesion, a positive Halmagi test. According to a number of authors, it is she who, as well as a test for the presence of hidden vertical strabismus (with central causes of acute dizziness, it is often detected) and the characteristics of nystagmus typical of a peripheral lesion (does not change direction depending on the direction of gaze, etc.), allow verify the diagnosis.
The diagnosis is confirmed using a caloric test, in which there is an areflexia of the vestibular system on the side of the lesion.
In a rare variant, accompanied by damage to the lower branch of the vestibular nerve, such a test will be negative, however, vestibular neuronitis can be diagnosed by conducting a study of vestibular evoked potentials. Also, signs of diclofenac online are observed during MRI with gadolinium, the study will also exclude the diagnosis of stroke and multiple sclerosis.
Treatment of vestibular neuronitis should be aimed at reducing the degree of dizziness, stopping vomiting (symptomatic therapy), as well as accelerating vestibular compensation.
Symptomatic therapy is reduced to the appointment of the so-called vestibular suppressants. The drug of choice in this case is dimenhydrinate in dosages of 50-100 mg 4 times a day at regular intervals. Metoclopramide, benzodiazepines, and phenothiazines can also be used. When vomiting, injectable forms of drugs are used (cerucal, latran i / m). The duration of therapy with vestibular suppressants is determined by the severity and duration of the presence of dizziness, they are rarely used for more than 3 days, because symptomatic therapy with drugs of this series inhibits recovery, although it brings relief to the patient.
To restore vestibular function, the best way is to use vestibular gymnastics, you can learn more about the exercises by clicking on the appropriate link.
The combined work of the vestibular, visual and proprioceptive analyzers makes it possible to stop sensory mismatch. It should be remembered that the first days of exercise may lead to some deterioration in well-being, but therapy should not be stopped. The tactics of vestibular rehabilitation and the nature of the exercises directly correlate with the stage of neuronitis, in more detail you can see this relationship in the table in the figure below.
The positive use of methylprednisolne in stepwise therapy with the gradual withdrawal of the drug has also been shown. The use of antiviral antiherpetic drugs (valacyclovir, acyclovir, etc.) did not show an improvement in the recovery of vestibular function.