Dijagnostika post-COVID-19 vestibularnih poremećaja: retrospektivna kohortna studija

Siniša Maslovara, Ivan Kristić, Silva Butković Soldo, Olivera Čejić, Tena Velki

Pozadina i cilj: Premda je COVID-19 dominantno respiratorna bolest, često je praćen i brojnim neurološkim simptomima. U sklopu sindroma post-COVID-19 bilježimo pojavu različitih simptoma, među njima i vrtoglavice, na koje treba obratiti posebnu pozornost u današnjoj otoneurološkoj dijagnostici, jer post-COVID-19 vrtoglavice čine ne mali udio od 12,66% u ukupnom broju pacijenata oboljelih od poremećaja ravnoteže. Ispitanici i metode: U studiji smo obuhvatili 40 pacijenata s vrtoglavicom, razvijenom u sklopu kroničnog sindroma COVID-19, koji su se na pregled javili nakon prosječno oko dva mjeseca od završetka infekcije SARS-CoV-2. Prikazali smo utjecaj bolesti na rezultate laboratorijskih pretraga vestibularnog sustava, među njima na videonistagmografiju (VNG), video head impulse test (vHIT) i vestibularne evocirane mišićne potencijale (VEMP). Rezultati: Među pacijentima je očekivano bila najveća skupina onih s akutnom jednostranom perifernom vestibulopatijom (AUPVP). Značajan udio činili su pacijenti s benignom paroksizmalnom položajnom vrtoglavicom (BPPV), a zabilježeni su i slučajevi vestibularne migrene i Ménièreove bolesti. Laboratorijska vestibulološka dijagnostika pokazala je značajno veći udio patoloških nalaza u dvotoplinskom testu prema Fitzgerald-Hallpikeu učinjenom u sklopu VNG baterije testova, u odnosu na nalaze vHIT i VEMP. Zaključak: Pokazalo se da kalorički test prema Fitzgerald- Hallpikeu koji ispituje vestibularnu funkciju u najnižim dijelovima vestibularnoga frekvencijskog spektra najbolje korelira s različitim oblicima akutnih i kroničnih vestibularnih lezija post-COVID-19, u odnosu na vHIT i VEMP pretrage. Ovo upućuje na zaključak da se u dijagnostici post-COVID-19 vrtoglavica možemo osloniti na Fitzgerald-Hallpikeov kalorički test kao na najpouzdaniji izvor podataka o stanju vestibularnog osjetila.

Background and Objective: Although COVID-19 is predominantly a respiratory disease, it is often accompanied by numerous neurological symptoms. As a part of the post-COVID-19 syndrome, we note the appearance of various symptoms, among them dizziness, which should be paid special attention to in today’s otoneurological diagnostics, because the post-COVID-19 dizziness accounts for a significant share of 12.66% in the total number of patients suffering from balance disorders. Patients and Methods: Our study involved 40 patients suffering from vertigo, which has developed as a part of a chronic COVID-19 outbreak. On average, the
aforementioned patients were appointed for an examination approximately two months subsequent to the end of the SARS-CoV-2 infection. We examined the impact of the disease on the results of laboratory tests of the vestibular system, including VNG (videonystagmography), video HIT (head impulse test), and VEMP (vestibular evoked myogenic potential). Results: As expected, the largest patient group was the one comprising those with an acute unilateral peripheral vestibulopathy (AUPVP). A significant proportion of patients, those suffering from benign paroxysmal positional vertigo (BPPV) was detected, as were the cases of vestibular migraine and Ménière’s disease. Laboratory-based diagnostics demonstrated the largest share of pathological findings in the Fitzgerald- Hallpike bithermal caloric test, performed as a part of the VNG battery of tests. Conclusion: It has been shown that the bithermal caloric test, which corresponds to the lowest part of the frequency spectrum, correlates best with various forms of acute and chronic post-COVID-19 vestibular lesions compared to video HIT and VEMP examinations. This signifies that in the diagnosis of post-COVID-19 dizziness, we can rely on the Fitzgerald-Hallpike test as the most reliable source of data pertaining to the condition of a vestibular sense.