Vestibular neuritis

Background

• 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

Diagnosis

Clinical Features

• 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

Workup

See Vertigo

Differential Diagnosis

Vertigo

• Vestibular/otologic
  • Benign paroxysmal positional vertigo (BPPV)
  • Traumatic (following head injury)
  • Infection
    • Labyrinthitis
    • Vestibular neuritis
    • Ramsay Hunt syndrome
  • 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

Treatment

• Treat associated vertigo symptomatically

See Also

• Vertigo
• Dizziness
• Labyrinthitis

Source

UpToDate