Vestibular neuritis: Difference between revisions

Latest revision as of 15:18, 1 June 2022

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

Background

Also known as vestibular neuronitis
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
May differentiate from labyrinthitis which technically should have hearing loss
Prevalence peaks at 40-50 years of age

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

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

Vertigo

Vestibular/otologic
- Benign paroxysmal positional vertigo (BPPV)
- Traumatic (following head injury)
- Infection
- Ménière's disease
- Ear foreign body
- Otic barotrauma
- Otosclerosis
Neurologic
- Cerebellar stroke
- Vertebrobasilar insufficiency
- Lateral Wallenberg syndrome
- Anterior inferior cerebellar artery syndrome
- Neoplastic: cerebellopontine angle tumors
- Basal ganglion diseases
- Vertebral Artery Dissection
- Multiple sclerosis
- Infections: neurosyphilis, tuberculosis
- Epilepsy
- Migraine (basilar)
Other
- Hematologic: anemia, polycythemia, hyperviscosity syndrome
- Toxic
  - Alcohol
  - Aminoglycosides
- Chronic renal failure
- Metabolic
  - Thyroid Disease
  - Hypoglycemia

Evaluation

See vertigo

Management

Treat associated vertigo symptomatically

Disposition

References

Authors:

@@ Line 1: / Line 1: @@
+''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 pts
+*Also known as vestibular neuronitis
+*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
+**May be [[viruses|viral]] or postviral inflammatory disorder affecting vestibular portion of CN VIII
+*May differentiate from [[labyrinthitis]] which technically should have hearing loss
+*Prevalence peaks at 40-50 years of age
 ==Clinical Features==
-*Acute, rapid onset of severe vertigo w/ N/V and gait instability
+*Acute, rapid onset of severe [[vertigo]] with [[nausea/vomiting]] and gait instability
-*Nystagmus
+*[[Nystagmus]]
-**Unilateral, horizontal or horizontal-torsional that is suppressed w/ visual fixation
+**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
-==Diagnosis==
+==Differential Diagnosis==
-*HINTS Exam can reliably distinguish peripheral cause from cerebellar/brain stem CVA
-**1. Head Impulse Testing
-***Tests vestibulo-ocular reflex
-***Have pt fix their eyes on your nose
-***Move their head in the horizontal plane to the left and right
-****If reflex is intact their eyes will stay fixed on your nose
-****If reflex is abnormal eyes will move w/ their head and won't stay fixed on your nose
-***It is reassuring if the reflex is abnormal!(due to dysfunction of the nerve)
-**2. Nystagmus
-***Benign nystagmus only beats in one direction no matter which direction their eyes look
-***Bad nystagums beats in every direction their eyes look
-****If pt looks left, get left nystagmus, if looks right, get right-beating nystagmus
-**3. Test of Skew
-***Vertical dysconjugate gaze is bad
-***Alternating cover test
-****Have pt look at your nose w/ their eyes and then cover one eye
-****When rapidly uncover the eye look to see if the eye quickly moves to re-align
-**If any of the above 3 tests are consistent w/ CVA obtain full work-up (including MRI)
-==DDX==
 *Cerebellum lesion
-**Nystagmus
+**[[Nystagmus]]
 ***Not suppressed with visual fixation
 ***May be other than horizontal or horizontal-torsional
 ***May change direction with gaze
-**Ataxia
+**[[Ataxia]]
-**Pt may have limb dysmetria, dysarthria, or HA
+**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, sensory loss, loss of corneal reflex, dysphagia, limb ataxia
+***Ipsilateral [[horner's syndrome|Horner's]], loss of corneal reflex, [[dysphagia]], contralateral [[numbness|loss of pain]]/temp
-==Treatment==
+{{Vertigo DDX}}
+==Evaluation==
+*See [[vertigo]]
+==Management==
 *Treat associated vertigo symptomatically
-==Source==
+==Disposition==
-UpToDate
+==See Also==
+*[[Vertigo]]
+*[[Dizziness]]
+*[[Labyrinthitis]]
-[[Category:Neuro]]
+==References==
+<references/>
+[[Category:Neurology]]