Der akute Vestibularisausfall

Abstract

Acute vestibular paralysis may not be considered as a nosologic entity but as a syndrome. Symptomatology (vertigo, spontaneous and provoked vestibular nystagmus, absence of cochlear signs) shows an uniform picture. The results of the caloric test as well as the nystagmic responses induced by galvanic stimulation and the development of central vestibular compensation however indicate that the site of the lesion is not only confined to the labyrinth but may also occur at the level of the peripheral neuron or even the vestibular nuclei. Etiology and pathology are still vague. Our own clinical observations as well as the scarce data in literature about morphological and experimental studies suggest in a way that vascular and infectious disorders are of importance as primary releasing factors. Hypothetically, vestibular loss of function may either be caused by a disturbance of labyrinthine microcirculation, initiated in a great majority of cases by infection, or by a direct lesion of the peripheral neuron as well as the vestibular nuclei. Retrolabyrinthine lesions may be due to menigoencephalitis, caused by a neurotropic virus or other infectious agents such as Toxoplasma gondii. Acute vestibular paralysis should be strictly distinguished from vestibular neuronitis. While vestibular paralysis is a syndrome, vestibular neuronitis must be considered as a nosologic entity, including a lesion of the peripheral neuron as well as evidence of an infectious event.

Long-term course and relapses of vestibular and balance disorders

“…What is the long-term recurrence rate of VN? (Meran and Pfaltz, 1975;Bergenius and Borg, 1983;Matsuo and Sekitani, 1985;Silvoniemi, 1988;Fetter and Dichgans, 1990;Okinaka et al, 1993;Bergenius and Perols, 1999;Ochi et al, 2003;Shupak et al, 2003;Strupp et al, 2004). There is a tendency for recovery to increase over time, with most of the regain of function occurring within the first month after onset.…”

“…There are numerous, mostly retrospective rather than prospective studies on the rate of complete or incomplete recovery of vestibular function as measured by the nystagmus response to caloric irrigation (Meran and Pfaltz, 1975, Bergenius and Borg, 1983, Matsuo and Sekitani, 1985, Silvoniemi, 1988, Fetter and Dichgans, 1990, Okinaka et al, 1993, Bergenius and Perols, 1999, Ochi et al, 2003, Shupak et al, 2003, Strupp et al, 1998, 2004. These studies are very difficult to compare, because of their different study design, the number of patients included, diagnostic criteria, definition of recovery, and duration of follow-up.…”

Akuter Vestibularisausfall

“…Die Erkrankung kann als vestibulares Äquivalent des Hörsturzes aufgefaßt werden [12]. Andere Hirnnerven sind nicht betroffen, es finden sich keine Zeichen anderweitiger zentralnervöser Störungen [3,5,7,10,12,14]. Es wird ein Spontannystagmus zur gesunden Seite beobachtet, der beim Blick zur gesunden Seite zunimmt (richtungsbestimmter Spontannystagmus).…”

Neuronitis vestibularis – Eigentümlichkeiten der thermischen Reaktionen

“…Während [5,6,8,9]. Der Heilungsprozess war nicht gleichmässig, Rezidive, Verschlechterungen und Verbesserungen wechselten sich ab.…”