Vestibular neuritis: Difference between revisions

Revision as of 04:43, 29 February 2012

Benign, self-limited disorder associated with complete recovery in most pts
- Must distinguish from acute vascular lesions of the CNS
Pathophysiology
- May be viral or postviral inflammatory disorder affecting vestibular portion of CN VIII
Some sources consider Vestibular Neuritis and Labyrinthitis to be the same thing
- Some differentiate based on auditory symptoms

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

Cerebellum lesion
- Nystagmus
  - Not suppressed with visual fixation
  - May be other than horizontal or horizontal-torsional
  - May change direction with gaze
- Ataxia
- Pt may have limb dysmetria, dysarthria, or HA
- 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

UpToDate

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 **Some differentiate based on auditory symptoms
-==Clinical Features==
+==Diagnosis==
+===Clinical Features===
 *Acute, rapid onset of severe vertigo w/ N/V and gait instability
 *Nystagmus
@@ Line 14: / Line 15: @@
 *Unlike BPPV and Meniere lasts several days and does not recur
-==Diagnosis==
+==Workup==
-*HINTS Exam can reliably distinguish peripheral cause from cerebellar/brain stem CVA
+See [[Vertigo]]
-**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==