Initial Degree of Spontaneous Nystagmus Affects the Length of Hospitalization of Patients With Vestibular Neuritis

Abstract

Objective: To assess factors predicting vestibular neuritis (VN) prognosis at an early stage. Study Design: Retrospective chart review. Setting: University hospital. Patients: Sixty-five patients with VN, between 2014 and 2018. Interventions: Bithermal caloric test, rotatory chair test, subjective visual horizontal and vertical, cervical visual myogenic evoked potential test, and visual head impulse test (vHIT). Main Outcome Measures: Hospitalization duration. Results: The mean hospitalization duration was 4.6 ± 1.4 days. Mean caloric weakness was 65.5 ± 20.6%. For the vHIT, gain in both anterior and horizontal semicircular canal (SCC) was statistically significantly different between the lesion and intact sides (p < 0.001). Backward conditional regression analysis revealed that a higher degree of spontaneous nystagmus (SN) (EXP[B] = 1.104, 95% confidence interval [CI] = 1.012–1.204, p = 0.026), and a lower caloric paresis (CP) value (EXP(B) = 1.033, 95% CI = 1.000–1.075, p = 0.047) were associated with 5 days or more of hospitalization. The cut-off value of SN was 12.05 degrees/s for increased hospital stay. Four weeks after discharge from hospital, five patients (8.9%) had persistent SN, and 19 (33.9%) and 28 (50.0%) had a positive HIT and nystagmus during head-shaking, respectively. Patients with persistent nystagmus at 1 month had more severe initial SN (p < 0.05). Conclusion: Only the degree of SN at the initial evaluation affected both the hospitalization period and the bed-side examination results at 1 month after discharge in patients with VN.

Clinical Characteristics of Unsustainable Vertigo In Patients With Vestibular Neuritis

“…The explanation might be that SN is the most prominent indicator of static vestibular imbalance. Previous study has found that initial degree of SN affects the duration of hospitalization, and VN patients with higher SN degree at the initial evaluation tended to have persistent SN [23]. VN patients with lower occurrence of SN experienced mild vestibular syndromes since their static imbalance was incompletely damaged or quickly recovered.…”

Update on Nystagmus and Other Ocular Oscillations

“…The presentation of significant spontaneous nystagmus is associated with hospitalization for ≥5 days and nystagmus persisting at 1 month after discharge (with a cutoff of 12.1°/s) in patients with vestibular neuritis (VN). 13 Two of three patients with delayed endolymphatic hydrops showed a typical horizontal-torsional nystagmus beating to the healthy side, whereas the third showed initial upbeat nystagmus with a slight torsional component that evolved into horizontal-torsional nystagmus beating to the healthy side. Initial upbeat nystagmus might reflect inhibition of the superior semicircular canal in the involved ear.…”