THERAPEUTIC APPROACH TO ACUTE VESTIBULAR NEURITIS: EMERGENCY PROTOCOLS
DOI:
https://doi.org/10.56238/levv17n57-016Keywords:
Vestibular Neuritis, Vertigo, HINTS Protocol, Vestibular Rehabilitation, Differential Diagnosis, Medical EmergenciesAbstract
Vestibular neuritis is one of the most frequent causes of acute vestibular syndrome treated in emergency departments, characterized by intense and prolonged rotatory vertigo, associated with nausea, vomiting, and postural instability, without hearing impairment or focal neurological deficits. The main clinical challenge in the acute phase is differentiating between peripheral and central etiologies, especially stroke of the posterior circulation. A detailed clinical examination, with emphasis on the HINTS protocol, associated with complementary methods such as video head impulse testing (vHIT) and vestibular evoked myogenic potentials (VEMP), constitutes the diagnostic cornerstone. Therapeutic management in the emergency setting is based on brief symptomatic control, judicious use of corticosteroids in selected cases, and early initiation of vestibular mobilization and rehabilitation, aiming to optimize central compensation. Most patients experience satisfactory functional recovery, with recurrence being rare. Early recognition and the application of structured protocols reduce morbidity, avoid unnecessary examinations, and improve clinical outcomes.
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References
GOPLEN, F. K.; WIIK, R. Patients admitted to hospital for vestibular neuritis in 2011-2021. Tidsskrift for Den norske legeforening, 2022.
HAEUSSLER, S. M. et al. Is Vestibular Neuropathy Rather a Neuritis? Cureus, v. 14, n. 10, p. e29959, 2022.
JASINSKA-NOWACKA, A.; NIEMCZYK, K. Application of a Video Head Impulse Test in the Diagnosis of Vestibular Neuritis. Life, v. 14, n. 6, p. 757, 2024.
SMITH, T. et al. Vestibular Neuronitis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2023.
STRUPP, M. et al. Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria. Journal of Vestibular Research, v. 32, p. 389-406, 2022.
Halmagyi, G. M.; Curthoys, I. S. Vestibulo-ocular reflex testing and clinical interpretation. Journal of Neurology, v. 269, n. 1, p. 15–28, 2022.
Kattah, J. C.; Talkad, A. V.; Wang, D. Z.; Hsieh, Y. H.; Newman-Toker, D. E. HINTS to diagnose stroke in the acute vestibular syndrome: updated evidence and clinical implications. Stroke, v. 55, n. 2, p. 487–495, 2024.
McGarvie, L. A.; MacDougall, H. G.; Curthoys, I. S.; Halmagyi, G. M. Advances in video head impulse testing for acute vestibular disorders. Frontiers in Neurology, v. 14, p. 1178452, 2023.
Herdman, S. J.; Hall, C. D.; Schubert, M. C.; Das, V. E. Vestibular rehabilitation: mechanisms, indications, and evidence-based practice. Journal of Neurologic Physical Therapy, v. 47, n. 1, p. 3–17, 2023.
Cohen, H. S.; Kimball, K. T.; Jenkins, H. A. Early vestibular rehabilitation and prevention of persistent postural-perceptual dizziness. Otology & Neurotology, v. 45, n. 4, p. 412–420, 2024.
EDLOW, J. A. et al. Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE-3): Acute dizziness and vertigo in the emergency department. Academic Emergency Medicine, v. 30, p. 442–486, 2023. doi:10.1111/acem.14728.
BALOH, R. W. Vestibular neuritis. New England Journal of Medicine, v. 348, p. 1027–1032, 2003. doi:10.1056/NEJMcp021154.
KARLBERG, M. L.-Å.; MAGNUSSON, M. Treatment of acute vestibular neuronitis with glucocorticoids. Otology & Neurotology, v. 32, n. 7, p. 1140–1143, 2011. doi:10.1097/MAO.0b013e3182267e24.
MORRISON, M. et al. Automated alternate cover test for “HINTS” assessment: a validation study. European Archives of Oto-Rhino-Laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery, v. 279, n. 6, p. 2873–2879, 2022. doi:10.1007/s00405-021-06998-w.
