• Clinical science

Vestibular neuritis

Summary

Vestibular neuritis is idiopathic inflammation of the vestibular nerve that most frequently occurs following viral infections of the upper airways. The disorder manifests with acute-onset vertigo, nausea, vomiting, and gait instability in otherwise healthy patients. Management involves bed rest, corticosteroids, and antivertigo agents (e.g., dimenhydrinate); vestibular rehabilitation therapy may accelerate recovery. Symptoms typically resolve in 2–3 weeks with treatment.

Etiology

  • Vestibular neuritis is an idiopathic disease.
  • It tends to occur more often after upper airway infections [1]

References:[2]

Clinical features

  • Acute onset of symptoms in otherwise healthy patients. Severe symptoms last for 1–2 days, mild symptoms may persist for weeks or even months:
  • 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:[2][3]

Diagnostics

Vestibular neuritis is a clinical diagnosis.

  • Positive head thrust test: The examiner turns the patient's head rapidly towards the affected side; the test is considered positive if the patient is unable to maintain visual fixation.
  • Imaging studies (to rule out stroke or brain tumors, but 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 to rule out a lateral medullary/cerebellar stroke!

References:[2]

Differential diagnoses for vertigo

Definitions

  • Dizziness: an umbrella term commonly used by patients to describe a variety of sensations, including vertigo, presyncope, imbalance, and confusion.
  • Vertigo: the sensation of self-motion (internal vertigo) or one's surroundings spinning while stationary (external vertigo)
  • Presyncope (lightheadedness): near loss of consciousness; most commonly due to a drop in systemic blood pressure or hypoxia

Differential diagnosis of vertigo-associated disorders

DDx

Ménière 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
Other symptoms
  • 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

Central vs peripheral vertigo

Central vertigo Peripheral vertigo
Site of underlying disorder
Associated cerebellar symptoms (e.g., ataxia, dysmetria)
  • Marked
  • Absent or mild
Sense of motion
  • Mild
  • Severe
Associated skew deviation
  • Present
  • Absent
Associated nystagmus
  • Can be torsional, horizontal, or vertical
  • Direction of nystagmus changes with gaze change.
  • Gaze fixation worsens nystagmus.
  • Torsional and horizontal (never vertical)
  • Direction of nystagmus does not change with gaze change.
  • Gaze fixation improves nystagmus.
Associated hearing loss and/or tinnitus
  • Rare
  • Common
Associated focal neurological findings (e.g., diplopia)
  • Common
  • Rare
Causes

References:[4][5][3]

Treatment

References:[2][4]

last updated 02/27/2020
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