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

DDX

• 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

• Treat associated vertigo symptomatically

See Also

• Vertigo
• Dizziness
• Labyrinthitis

Source

UpToDate