Vestibular neuritis: Difference between revisions
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**Some differentiate based on auditory symptoms | **Some differentiate based on auditory symptoms | ||
==Clinical Features== | |||
*Acute, rapid onset of severe vertigo w/ N/V and gait instability | *Acute, rapid onset of severe vertigo w/ N/V and gait instability | ||
*Nystagmus | *Nystagmus | ||
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**Does not change direction with gaze | **Does not change direction with gaze | ||
*Unlike BPPV and Meniere lasts several days and does not recur | *Unlike BPPV and Meniere lasts several days and does not recur | ||
== Differential Diagnosis== | == Differential Diagnosis== | ||
{{Vertigo DDX}} | {{Vertigo DDX}} | ||
==Diagnosis== | |||
*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 | |||
==Treatment== | ==Treatment== | ||
*Treat associated vertigo symptomatically | *Treat associated vertigo symptomatically | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
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*[[Labyrinthitis]] | *[[Labyrinthitis]] | ||
== | ==References== | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 13:24, 10 June 2015
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
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
Differential Diagnosis
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
- Chronic renal failure
- Metabolic
Diagnosis
- 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
- Nystagmus
- 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
- Usually associated with other symptoms of Wallenberg syndrome (lateral medulla infarct)
Treatment
- Treat associated vertigo symptomatically