Vestibular Neuritis (Neuronitis)

Some sources consider vestibular neuritis and labyrinthitis to be the same thing (some differentiate based on auditory symptoms)

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
    • Alcohol
    • Aminoglycosides
  • Chronic renal failure
  • Metabolic
    • Thyroid Disease
    • Hypoglycemia

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
• 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

Management

• Treat associated vertigo symptomatically

See Also

• Vertigo
• Dizziness
• Labyrinthitis

References

Authors

Jordan Swartz, Ross Donaldson, Claire, Daniel Ostermayer, Neil Young