We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Vestibular Neuritis (Neuronitis)
From WikEM
(Redirected from Vestibular Neuritis)
Some sources consider vestibular neuritis and labyrinthitis to be the same thing (some differentiate based on auditory symptoms)
Contents
Background
- 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
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
Vertigo
- Vestibular/otologic
- Benign Paroxysmal Positional Vertigo (BPPV)
- Traumatic (following head injury)
- Infection
- Labyrinthitis
- Vestibular Neuritis (Neuronitis)
- Ramsay Hunt syndrome
- Meniere's disease
- Ear foreign body
- Otic barotrauma
- Neurologic
- Cerebellar stroke
- Vertebrobasilar insufficiency
- Lateral Wallenberg syndrome
- Anterior inferior cerebellar artery syndrome
- Neoplastic: cerebellopontine angle tumors
- Basal ganglion diseases
- Vertebral Artery Disssection
- Multiple sclerosis
- Infections: neurosyphilis, tuberculosis
- Epilepsy
- Migraine (basilar)
- Other
- Hematologic: anemia, polycythemia, hyperviscosity syndrome
- Toxic
- Chronic renal failure
- Metabolic
Evaluation
- 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
- 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)
Management
- Treat associated vertigo symptomatically
