Hopp til hovedinnhold

Vestibularisnevritt

Sist oppdatert: Sist revidert:
Sist revidert av:

Definisjon:
Plutselig funksjonssvikt av n. vestibularis på en side. Antatt årsak er reaktivering av herpes simplex eller andre nevrotrope virus.
Forekomst:
I Norge ca. 10-15 sykehusinnleggelser per 100.000 per år.
Symptomer:
Akutt debut med vertigo ("alt går rundt"), kvalme/brekninger, falltendens. Svimmelheten er konstant tilstede, og symptomene forverres ved bevegelse, varighet mer enn 24 timer.  
Funn:
Vedvarende spontannystagmus mot frisk side, falltendens mot syk side, positiv hodeimpulstest mot syk side (HINTS+).
Diagnostikk:
Klinisk diagnose med objektivt målbart funksjonsutfall i nervus vestibularis. Kan skilles fra slag ved HINTS-tester (krever øvelse), ev. CT/MR
Behandling:
Selvhelbredende tilstand. Tidlig mobilisering, ev. antihistaminer og/eller antiemetika, ev. prednisolon. Krever oftest innleggelse for å skille fra hjerneslag.
  1. Adamec I, Krbot Skorić M, Handžić J, Habek M. Incidence, seasonality and comorbidity in vestibular neuritis. Neurol Sci 2015; 36: 91-5. pmid:25085434 PubMed  
  2. Brantberg K., Goplen FK, Bråthen G, et al. Should vestibular neuritis be treated with corticosteroids? Tidsskr Nor Laegeforen 2008; 128: 2062–63. Tidsskrift for Den norske legeforening  
  3. Karlberg M, Annertz M, Magnusson M. Acute vestibular neuritis visualized by 3-T magnetic resonance imaging with high-dose gadolinium. Arch Otolaryngol Head Neck Surg 2004; 130: 229–32.
  4. Esaki S, Goshima F, Kimura H, et al. Auditory and vestibular defects induced by experimental labyrinthitis following herpes simplex virus in mice. Acta otolaryngol 2011; 131: 684–91.
  5. Kattah JC, Talkad AV, Wang DZ, et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40, 3504–10.
  6. Chen CC, Cheng PW, Tseng HM, et al. Posterior cranial fossa tumors in young adults. Laryngoscope 2006; 116: 1678–81.
  7. Lempert T, Olesen J, Furman J, et al. Vestibular migraine: diagnostic criteria. J Vestib Res 2012; 22: 167–72.
  8. Newman-Toker DE, Kerber KA, Hsieh YH, et al. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med 2013; 20: 986-96. pmid:24127701 PubMed  
  9. McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD005397. DOI: 10.1002/14651858.CD005397.pub4. DOI  
  10. Fishman JM, Burgess C, Waddell A. Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Database Syst Rev 2011: 5: CD008607. doi: 10.1002/14651858.CD008607.pub2 DOI  
  11. Strupp M, Zingler VC, Arbusow V, et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med 2004; 351, 354–61.
  12. Shupak A, Issa A, Golz A, et al. Prednisone treatment for vestibular neuritis. Otol Neurotol 2008; 29: 368–374. PMID: 18317392 PubMed  
  13. Karlberg ML, Magnusson M. Treatment of acute vestibular neuronitis with glucocorticoids. Otol Neurotol 2011; 32: 1140–43.
  14. Tokle G, Mørkved S, Bråthen G, et al. Efficacy of Vestibular Rehabilitation Following Acute Vestibular Neuritis: A Randomized Controlled Trial. Otol Neurotol 2020; 41: 78-85. pmid:31789800 PubMed  
  15. Mandala M, Santoro GP, Awrey J, et al. Vestibular neuritis: recurrence and incidence of secondary benign paroxysmal positional vertigo. Acta Otolaryngol 2010; 130: 565–67.
  16. Kim YH, Kim KS, Kim KJ, et al. Recurrence of vertigo in patients with vestibular neuritis. Acta Otolaryngol 2011; 131: 1172–77.
  17. Kim HA, Hong JH, Lee H, et al. Otolith dysfunction in vestibular neuritis: recovery pattern and a predictor of symptom recovery. Neurology 2008; 70: 449. pmid:18250289 PubMed  
  18. Nuti D, MandalàM, Broman AT, Zee DS. Acute vestibular neuritis: prognosis based upon bedside clinical tests (thrusts and heaves). Ann N Y Acad Sci 2005; 1039: 359. pmid:15826989 PubMed  
  19. Baloh RW. Clinical practice. Vestibular neuritis.. N Engl J Med 2003; 348: 1027. pmid:12637613 PubMed  
  20. Huppert D, Strupp M, Theil D, et al. Low recurrence rate of vestibular neuritis: a long-term follow-up. Neurology 2006; 67: 1870-1. pmid:17130428 PubMed  
  21. Kammerlind AS, Ledin TE, Skargren EI, et al. Long-term follow-up after acute unilateral vestibular loss and comparison between subjects with and without remaining symptoms. Acta Otolaryngol 2005; 125: 946–53.
  22. Ohle R, Montpellier RA, Marchadier V, et al. Can Emergency Physicians Accurately Rule Out a Central Cause of Vertigo Using the HINTS Examination? A Systematic Review and Meta-analysis. Acad Emerg Med. 2020. PMID: 32167642 PubMed  
  • Ingard Løge, spesialist allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Frederik Kragerud Goplen, øre-nese-hals spesialist, overlege Haukeland sykehus, Bergen
  • Stein Helge Glad Nordahl, øre-nese-hals spesialist, overlege Haukeland sykehus, Bergen