Vestibular Neuritis (Neuronitis)

Some sources consider vestibular neuritis and labyrinthitis to be the same thing (some differentiate based on auditory symptoms)

Background

  • Benign, self-limited disorder associated with complete recovery in most patients
    • Must distinguish from acute vascular lesions of the CNS
  • Pathophysiology
    • May be viral or postviral inflammatory disorder affecting vestibular portion of CN VIII

Clinical Features

  • Acute, rapid onset of severe vertigo with nausea/vomiting and gait instability
  • Nystagmus
    • Unilateral, horizontal or horizontal-torsional that is suppressed with visual fixation
    • Does not change direction with gaze
  • Unlike BPPV and Meniere lasts several days and does not recur

Differential Diagnosis

Vertigo

Evaluation

  • Cerebellum lesion
    • Nystagmus
      • Not suppressed with visual fixation
      • May be other than horizontal or horizontal-torsional
      • May change direction with gaze
    • Ataxia
    • Patient may have limb dysmetria, dysarthria, or headache
    • Head impulse test usually normal
  • Brainstem infarction
    • Usually associated with other symptoms of Wallenberg syndrome (lateral medulla infarct)
      • Ipsilateral Horner's, loss of corneal reflex, dysphagia, contralateral loss of pain/temp

Management

  • Treat associated vertigo symptomatically

Disposition

See Also

References