Glucocorticosteroid Treatment in Acute Unilateral Vestibulopathy (Vestibular Neuronitis)

Medical History :

• severe and prolonged rotatory vertigo;
• acute onset, subacute, within 3 days;
• nausea ;
• imbalance.

Physical examination :

• spontaneous nystagmus beating towards the healthy ear (fast phase);
• no evidence of central vestibular lesion;
• Head impulse test abnormal, at least for the lateral semicircular canal (in some cases, the sign is only detectable for the 2 vertical semicircular canals with specific equipment, mostly not available in current practice);
• areflexia or hyporeflexia (asymetry > 70% calculated according to the classical Jongkees formula [slow phase velocity of the nystagmus in response to caloric stimulation at (right at 30°C + right at 44°C) - ( left at 30°C + left at 44°C ) / (right 30°C + left 30°C + right 44°C + left at 44°C) x 100], in the caloric test (10 cc in 20 s, at 30 and 44° C)

Exclusion Criteria:

• history of vestibular disorders other than benign paroxysmal positionning vertigo (BPPV);
• symptoms lasting more than 3 days;
• cochlear symptoms (deafness before, during or after vertigo);
• central oculomotor dysfunction;
• central vestibular dysfunction;
• signs of brain dysfunction (e.g. epilepsy);
• MRI (if done) abnormal central vestibular pathways;
• psychiatric disease (history of psychiatric disease);
• glaucoma ;
• acute infection (herpes simplex, herpes zoster, corneal herpes, chicken pox, tuberculosis);
• patients already on corticosteroids;
• severe diabetes (fasting blood glucose > 7 mmol/l);
• Severe hypertension (systolic >180; diastolic > 110);
• contraindications to glucocorticoids (peptic ulceration, osteoporosis confirmed by bone density tests or pathological fractures);
• allergy to glucocorticoids or mannitol
• malignant disease;
• cardiac disease (recent myocardial infarction, heart failure);
• liver dysfunction (cirrhosis)
• renal insufficiency;
• Pregnancy or breastfeeding.