Aerospace and Sub-Aquatic Medical Faculty, Aja University of Medical Sciences, Tehran, Iran.
Dept of Infectious and Tropical Diseases, Medical Faculty, Aja University of Medical Sciences, Tehran, Iran.
J Neurovirol. 2022 Dec;28(4-6):609-615. doi: 10.1007/s13365-022-01087-y. Epub 2022 Jul 25.
Vestibular neuritis was first reported in 1952 by Dix and Hallpike, and 30% of patients reporting a flu-like symptom before acquiring the disorder. The most common causes are viral infections, often resulting from systemic viral infections or bacterial labyrinthitis. Here we presented a rare case of acute vestibular neuritis after the adenoviral vector-based COVID-19 vaccination. A 51-year-old male pilot awoke early in the morning with severe vertigo, nausea, and vomiting after receiving the first dose of the ChAdOx1 nCoV-19 vaccine 11 days ago. Nasopharyngeal SARS-CoV-2 RT-PCR test and chest CT scan were inconclusive for COVID-19 pneumonia. Significant findings were a severe spontaneous and constant true-whirling vertigo which worsened with head movement, horizontal-torsional spontaneous nystagmus, abnormal caloric test, positive bedside head impulse tests, and inability to tolerate head-thrust test. PTA, MRI of the brain and internal auditory canal, and cerebral CT arteriography were normal. According to the clinical, imaging, and laboratory findings, he was admitted to the neurology ward and received treatment for vestibular neuritis. His vertigo increased gradually over 6-8 h, peaking on the first day, and gradually subsided over 7 days. Ten days later, the symptoms became tolerable; the patient was discharged with advice for home-based vestibular rehabilitation exercises. Despite the proper treatment and rehabilitation, signs of dynamic vestibular imbalances persisted after 1 year. Based on the Federal Aviation Administration (FAA) regulations, the Air Medical Council (AMC) suspended him from flight duties until receiving full recovery. Several cases of vestibular neuritis have been reported in the COVID-19 patients and after the COVID-19 vaccination. This is the first case report of acute vestibular neuritis after the ChAdOx1 nCoV-19 vaccination in a healthy pilot without past medical history. However, the authors believe that this is a primary clinical suspicion that must be considered and confirmed after complete investigations.
前庭神经炎于 1952 年由 Dix 和 Hallpike 首次报道，30%的患者在发病前有类似流感的症状。最常见的病因是病毒感染，通常由全身病毒感染或细菌性迷路炎引起。在这里，我们报告了一例在接受基于腺病毒载体的 COVID-19 疫苗接种后发生的急性前庭神经炎的罕见病例。一名 51 岁男性飞行员在接种第一剂 ChAdOx1 nCoV-19 疫苗 11 天后的清晨醒来时出现严重的眩晕、恶心和呕吐。鼻咽部 SARS-CoV-2 RT-PCR 检测和胸部 CT 扫描均不能排除 COVID-19 肺炎。显著的发现是严重的自发性和持续的真性眩晕，头部运动时加重，水平扭转性自发性眼震，异常的冷热试验，床边头脉冲试验阳性，无法耐受头推试验。纯音听阈测试、脑和内听道磁共振成像以及脑 CT 血管造影均正常。根据临床、影像学和实验室检查结果，他被收入神经内科病房，并接受前庭神经炎治疗。他的眩晕在 6-8 小时内逐渐加重，第 1 天达到高峰，7 天内逐渐缓解。10 天后，症状变得可以忍受；患者出院，建议在家进行前庭康复锻炼。尽管进行了适当的治疗和康复，1 年后仍存在动态前庭平衡障碍的迹象。根据联邦航空管理局（FAA）的规定，航空医疗委员会（AMC）暂停他的飞行任务，直到完全恢复。有几例 COVID-19 患者和 COVID-19 疫苗接种后出现前庭神经炎的报道。这是首例在无既往病史的健康飞行员中接受 ChAdOx1 nCoV-19 疫苗接种后发生急性前庭神经炎的病例报告。然而，作者认为这是一个初步的临床怀疑，必须在完成全面调查后进行考虑和确认。
