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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
