Vascular etiology of acute unilateral vestibulopathy

Purpose: to assess the probability of vascular etiology of acute unilateral vestibulopathy (AUVP) in patients through a comprehensive clinical and instrumental analysis.

Object and methods of the study. 150 patients (80 women and 70 men) with AUVP were examined. The subjective assessment of dizziness was assessed using the questionnaire «Dizziness handicap inventory», Ukrainian version (DHI-UA 2020). Patients underwent an otoneurological examination, in particular, assessment of gaze-induced and spontaneous nystagmus using VideoFrenzel (VisualEyes™ 505), head impulse test, saccade and smooth pursuit tests, otoscopy, audiometry. Differential diagnosis of acute vestibular syndrome was performed on the basis of clinical and neurological examination, HINTS test and magnetic resonance imaging of the brain. For differential diagnosis of the genesis of AUVP (inflammatory/vascular), the ABCD2 scale was used. Patients with AUVP were also assessed using the Hamilton anxiety scale.

Results. According to the conducted study, vestibular neuronitis of probable viral/inflammatory etiology was established in 65 (43.3%) people. Vascular factors of symptomatology were established in 78 (52.0%) patients. Thus, ischemic heart disease was detected in 49 (32.7%) people, in 30 (20.0%) patients AUVP occurred against the background of arterial hypertension and at the onset of symptoms was accompanied by high blood pressure at the level of 170.5±10.4 mm Hg. Atrial fibrillation was detected for the first time in 13 (8.7%) patients and atherosclerosis of extracranial arteries was detected in 21 (14.3%) patients. Several probable factors of AUVP were identified in 35 (23.3%) of the examined patients (ischemic heart disease, arterial hypertension, diabetes mellitus, atherosclerosis of extracranial arteries). In 7 (4.7%) patients, the cause of AUVP was not identified. In 45 (30%) patients, the risk according to ABCD2 was >4 — moderate risk of stroke. In 48 (32%) of all patients with AUVP, the score on the Hamilton Anxiety Scale, assessed on the 7th day of the disease, was >25, which indicated a degree of anxiety from moderate to severe.

Conclusion. AUVP occurs not only as a result of the inflammatory process, but can also be a consequence of cardiovascular risks. The ABCD2 scale can be used to assess the probability of vascular genesis of AUVP. The results prove the need for large-scale prospective controlled studies to clarify the vascular origin of AUVP. Determination of the etiological factor of AUVP will serve as a differentiated approach to the treatment strategy. Another probable risk factor for AUVP may be anxiety.

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