Walker Mark F
Mark F. Walker, MD Department of Neurology, Case Western Reserve University, Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA.
Curr Treat Options Neurol. 2009 Jan;11(1):41-5. doi: 10.1007/s11940-009-0006-8.
Vestibular neuritis is an acute peripheral vestibulopathy. It is thought to result from a reactivation of herpes simplex virus that affects the vestibular ganglion, vestibular nerve, labyrinth, or a combination of these. The symptoms are prolonged continuous vertigo, nausea and vomiting, and imbalance. In evaluating a patient with an acute vestibular syndrome, it is important not to miss a central cause, such as a brainstem or cerebellar stroke or hemorrhage, which could be life-threatening. Definitive central signs are not always present. Thus, any patient thought to have vestibular neuritis who has significant vascular risk factors should be evaluated for possible stroke. Most patients recover well from vestibular neuritis, even without treatment. Nonetheless, studies suggest that a course of oral steroids accelerates the recovery of vestibular function; whether steroids influence long-term outcome is less certain. Thus, until more data become available, it is reasonable to treat otherwise healthy individuals who present within 3 days of onset and to withhold steroids from those who are at higher risk of complications. Antiemetics and vestibular suppressants are useful acutely but should be withdrawn as soon as possible (preferably after the first several days), because their prolonged use may impede the process of central vestibular compensation. Early resumption of normal activity should be encouraged, to promote compensation. Directed vestibular rehabilitation therapy can further promote this process.
前庭神经炎是一种急性周围性前庭病变。它被认为是由单纯疱疹病毒再激活引起的，该病毒会影响前庭神经节、前庭神经、内耳迷路或这些部位的组合。症状包括持续性眩晕、恶心和呕吐以及平衡失调。在评估急性前庭综合征患者时，重要的是不要漏诊中枢性病因，如脑干或小脑中风或出血，这些可能危及生命。明确的中枢性体征并不总是存在。因此，任何被认为患有前庭神经炎且有显著血管危险因素的患者都应评估是否可能发生中风。大多数前庭神经炎患者即使未经治疗也恢复良好。尽管如此，研究表明口服类固醇疗程可加速前庭功能的恢复；类固醇是否会影响长期预后尚不确定。因此，在有更多数据可用之前，对于发病3天内就诊的健康个体进行治疗是合理的，而对于有较高并发症风险的患者则不使用类固醇。止吐药和前庭抑制剂在急性期有用，但应尽快停用（最好在最初几天之后），因为长期使用可能会阻碍中枢前庭代偿过程。应鼓励尽早恢复正常活动，以促进代偿。有针对性的前庭康复治疗可以进一步促进这一过程。
