Rofo 2020; 192(09): 854-861
DOI: 10.1055/a-1110-7441
Neuroradiology

Vestibular Nerve Atrophy After Vestibular Neuritis – Results from a Prospective High-Resolution MRI Study

Atrophie des Nervus vestibularis nach einem akuten Vestibularisausfall (Neuronitis vestibularis) – Ergebnisse einer prospektiven hochaufgelösten MRT-Untersuchung
Wolfgang Freund
1   Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
,
Frank Weber
2   Research, German Air Force Center of Aerospace Medicine, Fürstenfeldbruck, Germany
,
Daniel Schneider
1   Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
,
Ulrich Mayer
3   Cardiology, Private Practice, Ulm, Germany
,
Marc Scheithauer
4   Otolaryngology, University Hospital Ulm, Germany
,
Meinrad Beer
1   Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
› Institutsangaben

Abstract

Purpose Sudden unilateral peripheral vestibular deficit is mostly termed vestibular neuritis (VN), even if its cause or the exact location of the lesion remains unclear. Thus, therapy is mostly symptomatic. We aimed to prove if there is peripheral atrophy after VN with persistent canal paresis.

Methods After approval by the ethics committee and according to the declaration of Helsinki and with informed consent, ten patients with persistent canal paresis after VN and ten age-matched healthy controls were included. High-resolution measurement (in-plane resolution 0.2 mm) of the internal auditory canal (IAC) using a 3 D CISS sequence at 3 Tesla was performed. The course of the pertaining nerves was reconstructed in the 3 D dataset and the measurement was performed at 60 % of the length of the IAC. The cross-sectional areas of the superior (SVN) and inferior vestibular nerve (IVN) were taken independently by two blinded readers.

Results The interrater difference regarding the area was 22 %. We found significant atrophy of the SVN with a 24 % smaller area (p = 0.026) and found a smaller ratio of SVN/IVN on the symptomatic side (p = 0.017). Concerning single subject data, only 5 patients showed extensive atrophy of the NVS, while 5 patients did not. The time since symptom onset did not significantly influence the atrophy.

Conclusion MRI measuring of the area of the NVS after VN could detect atrophy after VN. However, only 5 patients exhibited marked atrophy, while the other 5 patients did not. With the background of stringent inclusion criteria (more than 6 months of symptom duration and proven persistent canal paresis), one has to wonder if there might be different etiologies behind the apparently identical symptoms.

Key Points:

  • MRI measuring of the area of the NVS after VN could detect atrophy after VN

  • Only half of the 10 researched patients showed atrophy, while the other patients did not

  • There are different etiologies to be suspected for VN

Citation Format

  • Freund W, Weber F, Schneider D et al. Vestibular Nerve Atrophy After Vestibular Neuritis – Results from a Prospective High-Resolution MRI Study. Fortschr Röntgenstr 2020; 192: 854 – 861

Zusammenfassung

Ziel Ein plötzlicher Funktionsverlust der Vestibularnerven wird meist als Neuronitis vestibularis (NV) bezeichnet, auch wenn die entzündliche Genese, aber auch der exakte Ort der Schädigung unklar sind. Die Therapie ist daher meist ungezielt symptomatisch. Daher sollte überprüft werden, ob nach einer NV mit persistierendem vestibulärem Ausfall eine Atrophie des Nervus vestibularis nachweisbar ist.

Material und Methoden Nach positivem Votum der Ethikkommission und in Übereinstimmung mit der Erklärung von Helsinki und Aufklärung und Einverständnis wurden je 10 Patienten mit gesichertem vestibulärem Defizit und 10 Alters-gematchte gesunde Kontrollpersonen eingeschlossen. Hochauflösende (0,2 mm in plane) Darstellung des inneren Gehörgangs erfolgte mit einer 3D-CISS-Sequenz in einem 3T-MRT. Der Verlauf der Nerven wurde im 3D-Datensatz rekonstruiert und als Messpunkt die Lage 60 % lateral im Meatus acusticus internus bestimmt. Die Querschnittsflächen wurden separat von 2 bezüglich der Klinik geblindeten Auswertern im Nervus vestibularis superior (SVN) und inferior (IVN) gemessen.

Ergebnisse Die Standardabweichung der beiden Auswerter betrug 22 %. Der erkrankte SVN war signifikant (p = 0,026) atrophisiert im Vergleich zu Kontrollpersonen mit einer 24 % kleineren Querschnittsfläche. Auch im Vergleich zum IVN zeigte sich die Atrophie als kleinerer Quotient SVN/IVN auf der symptomatischen Seite (p = 0,017). Auf Einzelpersonenebene war jedoch nur bei 5 Erkrankten eine massive Atrophie festzustellen, während 5 symptomatische SVN nicht atroph waren (dabei kein Einfluss der Symptomdauer).

Diskussion Die hochauflösende MRT des SVN konnte auf Gruppenebene eine signifikante Atrophie bei symptomatischen Patienten zeigen. Die Einschlusskriterien waren stringent (über 6 Monate Symptomdauer, messtechnisch bestätigtes bleibendes vestibuläres Defizit). Nachdem aber die Differenz durch massive Abweichung lediglich von der Hälfte der Patienten getragen wird, kann vermutet werden, dass unterschiedliche Ätiologien hinter dem homogenen klinischen Bild stecken.

Kernaussagen:

  • Hochauflösendes MRT kann die Atrophie des Nervus vestibularis superior nachweisen.

  • Nur die Hälfte der 10 untersuchten Patienten nach Neuritis vestibularis zeigte jedoch eine starke Atrophie.

  • Daher sollte weiter nach unterschiedlicher Ätiologie der klinisch homogen erscheinenden Erkrankung gesucht werden.



Publikationsverlauf

Eingereicht: 29. Juni 2019

Angenommen: 22. Januar 2020

Artikel online veröffentlicht:
20. Februar 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 
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