Zaubitzer Lena, Ludwig Sonja, Berkemann Michelle, Walter Beatrice, Jungbauer Frederic, Held Valentin, Hegemann Stefan C A, Rotter Nicole, Schell Angela
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Department of Neurology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Front Neurol. 2023 Mar 10;14:1134540. doi: 10.3389/fneur.2023.1134540. eCollection 2023.
The symptoms and severity of SARS-CoV-2 infection vary greatly across the spectrum, from asymptomatic infection to severe pneumonia with acute respiratory distress syndrome and even death. Dizziness is a frequently reported symptom of SARS-CoV-2 viral infection. However, the extent to which this symptom results from the effect of SARS-CoV-2 on the vestibular system remains unclear.
In the present single-center, prospective cohort study, patients with a previous SARS-CoV-2 infection underwent a vestibular assessment consisting of the Dizziness Handicap Inventory to assess dizziness during and after infection, a clinical examination, the video head impulse test, and the subjective visual vertical test. When the subjective visual vertical test result was abnormal, vestibular-evoked myogenic potentials were performed. Vestibular testing results were compared to pre-existing normative data of healthy controls. In addition, we performed a retrospective data analysis of patients admitted to hospital presenting with acute symptoms of dizziness who were also diagnosed with acute SARS-CoV-2 infection.
A total of 50 participants have been enrolled. During and after the SARS-CoV-2 infection, women were significantly more likely than men to suffer from dizziness. A significantly reduced semicircular canal or otolith function was not observed in either women or men. Acute SARS-CoV-2 infection was diagnosed in nine patients who presented to the emergency room with acute vestibular syndrome. Six of the patients exhibited acute unilateral peripheral vestibulopathy upon diagnosis. A different patient was diagnosed with vestibular migraine, and two individuals had a posterior inferior cerebellar artery infarct revealed by magnetic resonance imaging.
DISCUSSION/CONCLUSION: Overall, a persisting structural affection of the vestibular system by SARS-CoV-2 seems to be unlikely and could not be confirmed by vHIT, SVV, and VEMPS in our study. It seems possible but unlikely that SARS-CoV-2 induces acute vestibulopathy. Nevertheless, dizziness is a common symptom in patients with COVID-19, which should be taken and worked through seriously.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的症状和严重程度差异很大，从无症状感染到伴有急性呼吸窘迫综合征的严重肺炎甚至死亡。头晕是SARS-CoV-2病毒感染的常见症状。然而，这种症状在多大程度上是由SARS-CoV-2对前庭系统的影响所致仍不清楚。
在本单中心前瞻性队列研究中，既往感染过SARS-CoV-2的患者接受了前庭评估，包括用于评估感染期间和感染后头晕情况的头晕残障量表、临床检查、视频头脉冲试验以及主观视觉垂直试验。当主观视觉垂直试验结果异常时，进行前庭诱发肌源性电位检查。将前庭测试结果与健康对照者预先存在的标准数据进行比较。此外，我们对因急性头晕症状入院且也被诊断为急性SARS-CoV-2感染的患者进行了回顾性数据分析。
共招募了50名参与者。在SARS-CoV-2感染期间及之后，女性比男性更容易出现头晕。未观察到女性或男性的半规管或耳石功能有明显降低。9名因急性前庭综合征就诊于急诊室的患者被诊断为急性SARS-CoV-2感染。其中6名患者在诊断时表现为急性单侧周围性前庭病。另一名患者被诊断为前庭性偏头痛，两名患者经磁共振成像显示有小脑后下动脉梗死。
讨论/结论：总体而言，SARS-CoV-2对前庭系统持续存在结构性影响似乎不太可能，且在我们的研究中视频头脉冲试验、主观视觉垂直试验和前庭诱发肌源性电位检查均未证实这一点。SARS-CoV-2诱发急性前庭病似乎有可能但可能性不大。尽管如此，头晕是冠状病毒病（COVID-19）患者的常见症状，应予以认真对待并进行相应处理。
