• Clinical science

Vestibular neuritis

Abstract

Vestibular neuritis is a type of acute unilateral vestibulopathy of unknown origin, although it tends to occur after viral infection of the upper airways. The disorder presents with acute-onset vertigo, nausea, vomiting, and gait instability in otherwise healthy patients. Symptomatic treatment includes bed rest and medication, while rehabilitation involving vestibular exercises speeds up recovery. With proper treatment, symptoms typically disappear within 2–3 weeks.

Etiology

  • Vestibular neuritis is an idiopathic disease.
  • It tends to occur more often after upper airway infections

References:[1]

Clinical features

  • Acute onset in otherwise healthy patients. Severe symptoms last for 1–2 days, mild symptoms may persist for weeks or even months:
    • Severe vertigo
    • Nausea and vomiting
    • Gait instability
  • Increased risk of falling towards the affected side
  • Patient history may include recent infection of the upper airways.

No cochlear symptoms (e.g., hearing loss, tinnitus)!

References:[1]

Diagnostics

There is no confirmatory test. The diagnosis is therefore primarily based on clinical findings and the patient history.

  • Head thrust test: The examiner turns the patient's head rapidly towards the affected side → positive if the patient is unable to maintain visual fixation
  • Imaging studies (only used to rule out a stroke or a brain tumor; not for routine diagnostics!)
    • MRI
    • MRA
    • CT
  • Audiogram: unremarkable

Imaging studies are indicated in patients older than 60 years, as well as those with persistent vestibular symptoms, headache, vascular risk factors, or focal neurologic symptoms!

References:[1]

Differential diagnoses for vertigo

DDx

Ménière's disease Benign paroxysmal positional vertigo Persistent postural-perceptual dizziness Vestibular neuritis
Vertigo
  • Vertigo lasts for minutes to hours
  • Vertigo for only a few seconds
  • Vertigo is always triggered by movement (e.g., lying down, reclining)
  • Not actually vertigo, but a sensation of dizziness that lasts for at least 3 months
  • Severe vertigo for 1–2 days
  • Mild symptoms (e.g., nausea) may persist for weeks or months
Others
  • No cochlear symptoms
  • No cochlear symptoms
  • Patients often suffer from anxiety and/or depressive disorders
  • No cochlear symptoms
  • Patient history may include recent infection of the upper airways

References:[2]

Treatment

References:[1][2]