The acute vestibular dysfunction in emergency neurology

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Abstract

The aim of this study is to research the structure of acute vestibular disorders at the stage of the emergency room and to determine the frequency of occurrence of life-threatening conditions.

Material and methods. It was made the analysis of acute vestibular disorders at the stage of emergency room of the Neurology department of Clinical Hospital No. 7, City Clinical Hospital No. 18 and stroke center of Interregional Clinical Diagnostic Center in Kazan, Tatarstan Republic, Russian Federation, for the period 2016–2020. The diagnosis of vestibular disorders was established on the basis of clinical data. There were additional instrumental researches made in doubtful cases. Statistical data processing was made using Microsoft Excel 10.0 program.

Results. The study included 106 patients in total with reliably established pathology of the peripheral or central vestibular system. The peripheral or functional nature of vestibular disfunctions were identified in 84% patients. 57% patients had benign paroxysmal positional vertigo. 42% of these patients had repeated benign paroxysmal positional vertigo attack. Vestibular neuronitis and Ramsey Hunt syndrome were detected in 15% patients. Acute cerebrovascular origin was diagnosed in 10% patients (10 ischemic strokes and 1 transient ischemic attack). 1 patient had an Arnold–Chiari malformation with the development of occlusive hydrocephalus. So, 12 patients had a life-threatening cause of vestibular pathology, among them only 2 patients had isolated vestibular symptoms. Vestibular migraine was diagnosed in another 5% patients.

Conclusions. Life-threatening causes of vestibular pathology account for 11% of all cases. Focal neurological symptoms are the main “red flags” of systemic vertigo. Benign paroxysmal positional vertigo is detected in 57% of cases of vertigo in the emergency room.

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About the authors

Aleksandr Yu. Kazancev

Kazan State Medical University

Author for correspondence.
Email: engine90@bk.ru
ORCID iD: 0000-0001-9800-9940

Ассистент кафедры неврологии, нейрохирургии и медицинской генетики

Russian Federation, 420012, Kazan, Butlerov str., 49

Eduard Z. Yakupov

Kazan State Medical University; Scientific Research Medical Complex "Vashe Zdorovye"

Email: ed_yakupov@mail.ru

доктор медицинских наук, профессор, зав. кафедрой неврологии, нейрохирургии и медицинской генетики, руководитель Научно-исследовательского медицинского комплекса «Ваше здоровье», Образовательного Центра «Ваше здоровье»

Russian Federation, 420012, Kazan, Butlerov str., 49; 420097, Kazan, Dostoevsky str., 52

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2. Fig. 1. Neuroimaging data of individuals with acute cerebrovascular accident: A - magnetic resonance imaging in DWI mode (MRI DWI) in a patient with lesions in the trunk and cerebellum; B - MRI DWI of a patient with isolated acute vestibular syndrome; B - MRI DWI of a patient with vestibulocerebellar symptoms 1.5 hours after the onset of vertigo; D - computed tomogram of the same patient after 14 hours, development of cerebral edema and insertion into the foramen magnum

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3. Fig. 2. Occlusive hydrocephalus in a patient with Arnold-Chiari anomaly on a computed tomogram of the brain: А – В - axial sections, sharply expanded IV, III and lateral ventricles; D - sagittal section, prolapse of the cerebellar tonsils into the foramen magnum, sharply dilated cerebral ventricles original article

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Copyright (c) 2021 Kazancev A.Y., Yakupov E.Z.

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