- Clinical science
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.
- Vestibular neuritis is an idiopathic disease.
- It tends to occur more often after upper airway infections 
- 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.
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 or brain tumors, but not for routine diagnostics)
- 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!
- 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
|Vertigo|| || |
|Other symptoms|| || || |
|Central vertigo||Peripheral vertigo|
|Site of underlying disorder|
|Associated cerebellar symptoms (e.g., ataxia, dysmetria)|| || |
|Sense of motion|| || |
|Associated skew deviation|| || |
|Associated hearing loss and/or tinnitus|| || |
|Associated focal neurological findings (e.g., diplopia)|| || |
- Bed rest
- Corticosteroids (e.g., prednisolone)
- Symptomatic treatment
Vestibular rehabilitation therapy
- Vestibular rehabilitation is generally used to treat patients with permanent vestibular injury, but it may also speed up recovery in patients suffering from vestibular neuritis.