VESTIBULAR NEURONITIS: PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENT

Vestibularni neuritis (VN) jedan je od najčešćih perifernih uzroka vrtoglavice. Kalorimetrijsko ispitivanje vestibularnog organa zlatni je standard u dijagnostici VN-a. Ipak, novija istraživanja ističu praktičnost primjene kliničkih testova koji se izvode uz krevet bolesnika, a usporedivi su s osjetljivosti i specifičnosti u odnosu prema zlatnom standardu. Riječ je o »head thrust«, »head heave«, »head shake« i vibracijskom testu. Osim kalorimetrijskog testiranja kao zlatnog standarda u dijagnostici VN-a, vestibularni evocirani miogeni potencijali (VEMP) mogu razlikovati oštećenje gornje i donje grane vestibularnog živca, ali i periferno od centralnog oštećenja. Unatoč tomu što je u liječenju VN-a već dugo ustaljena primjena glukokortikoida, novija istraživanja opravdanost njihove upotrebe dovode u pitanje, a s druge se strane naglašava važnost fizikalne rehabilitacije. U ovome preglednom članku bit će iznesene najnovije spoznaje o patofiziologiji, dijagnostici i liječenju bolesnika s VN-om.Vestibular neuritis (VN) is one of the most common causes of peripheral vertigo. Caloric testing has been the traditional gold standard for detecting a peripheral vestibular deficit, but some recently developed bedside tests (head thrust, head heave, head shake and vibration test) were evaluated as a good alternative with similar sensitivity and specificity. These tests have shown both diagnostic value in the short term and prognostic value in the long term, and have availability and ease of use as an advantage. As an addition to clinical examination, vestibular evoked myogenic potentials can differentiate between involvement of superior and inferior branch of the vestibular nerve, but also between peripheral and central lesions. Although glucocorticoids are currently widely used in the treatment of VN, there is a lack of evidence for the validity of their administration. There are a number of high quality clinical trials that suggest vestibular rehabilitation exercises, which are based on the mechanisms of vestibular compensation, in the managment of VN. This review will focus on the latest developments in the pathophysiology, diagnosis and treatment of patients with VN

Vestibularni neuronitis: patofiziologija, dijagnoza i liječenje [Vestibular neuronitis: pathophysiology, diagnosis and treatment]

Vestibular neuritis (VN) is one of the most common causes of peripheral vertigo. Caloric testing has been the traditional gold standard for detecting a peripheral vestibular deficit, but some recently developed bedside tests (head thrust, head heave, head shake and vibration test) were evaluated as a good alternative with similar sensitivity and specificity. These tests have shown both diagnostic value in the short term and prognostic value in the long term, and have availability and ease of use as an advantage. As an addition to clinical examination, vestibular evoked myogenic potentials can differentiate between involvement of superior and inferior branch of the vestibular nerve, but also between peripheral and central lesions. Although glucocorticoids are currently widely used in the treatment of VN, there is a lack of evidence for the validity of their administration. There are a number of high quality clinical trials that suggest vestibular rehabilitation exercises, which are based on the mechanisms of vestibular compensation, in the managment of VN. This review will focus on the latest developments in the pathophysiology, diagnosis and treatment of patients with VN

Postural orthostatic tachycardia syndrome associated with multiple sclerosis

BACKGROUND: The aim of this study was to determine if there is a difference in the frequency of postural orthostatic tachycardia syndrome (POTS) in patients with multiple sclerosis (MS) compared to patients with symptoms of orthostatic intolerance and with no evidence of MS or other neurological illness. ----- METHODS: We analyzed data gathered from 293 patients who underwent the head-up tilt table test protocol. Group 1 included prospectively analyzed 112 with MS and group 2 included retrospectively analyzed 181 patients who were evaluated because of symptoms of orthostatic intolerance, and with no evidence of MS or other neurological illness. If POTS was identified the head-up tilt table test was repeated and supine as well as standing serum epinephrine and norepinephrine were determined. ----- RESULTS: POTS was identified in 39 patients: 21 (19%) in the MS group comparing to 18 (10%) in the non MS group (p=0.035). There was no difference between groups in the occurrence of POTS associated syncope (p=0.52). There was no difference between groups in the epinephrine or norepinephrine in supine and standing positions. While both standing epinephrine and norepinephrine levels were significantly higher compared to levels in the supine position in the non MS group, only standing norepinephrine levels were significantly higher in the MS group. ----- CONCLUSIONS: The results of this study suggest that POTS is associated with MS