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Vestibular syndromes after COVID-19 vaccination: a prospective cohort study

Dizziness and vertigo are common post-COVID-19-vaccination symptoms. In this article the authors aimed to prospectively evaluate objective central or peripheral-vestibular function in patients with dizziness, vertigo, and postural symptoms that started or worsened after COVID-19-vaccination.

Out of 4,137 patients who presented between 01/2021 and 04/2022 at the German Center for Vertigo and Balance Disorders, LMU Munich, the authors identified 72 patients (mean age 47yrs) with enduring vestibular symptoms following COVID-19-vaccination. All underwent medical history-taking, neurological and neuro-otological workup with bithermal calorics, video head-impulse-test, orthoptics, and audiometry. Diagnoses were based on international criteria. The distribution of diagnoses was compared to a cohort of 39,964 patients seen before the COVID-19-pandemic. Symptom onset was within the first four weeks post-vaccination. The most prevalent diagnoses were somatoform vestibular disorders (34.7%), vestibular migraine (19.4%), or overlap syndromes of both (18.1%). These disorders were significantly overrepresented compared to the pre-pandemic control-cohort. 36% of patients with somatoform complaints reported a positive history of depressive or anxiety disorders. Nine patients presented with benign paroxysmal positional vertigo, three with acute unilateral vestibulopathy, and seven with different entities (vestibular paroxysmia, Menière’s disease, polyneuropathy, ocular muscular paresis). Causally related central-vestibular deficits were lacking. Novel peripheral-vestibular deficits were found in four patients. The authors concluded that newly induced persistent vestibular deficits following COVID-19-vaccination were rare. The predominant causes of prolonged vestibular complaints were somatoform vestibular disorders and vestibular migraine, possibly triggered or aggravated by stress-related circumstances due to the COVID-19-pandemic or vaccination. An increase of other central or peripheral vestibular syndromes after COVID-19-vaccination was not observed.

Gerb J, Becker-Bense S, Zwergal A, Huppert D. Vestibular syndromes after COVID-19 vaccination: a prospective cohort study. Eur J Neurol. 2022 Sep 3.

doi: 10.1111/ene.15546