eMedicine Specialties > Emergency Medicine > Neurology

Vestibular Neuronitis: Follow-up

Author: Keith A Marill, MD, Faculty, Department of Emergency Medicine, Massachusetts General Hospital
Contributor Information and Disclosures

Updated: Nov 6, 2009

Follow-up

Further Inpatient Care

  • Consider admission for patients who have persistent vomiting despite treatment and for patients unable to walk satisfactorily.

Further Outpatient Care

  • Refer patients for rapid follow-up to their primary care physician, a neurologist, or ear, nose, and throat specialist.

Inpatient & Outpatient Medications

  • Outpatient treatment usually continues after discharge.
  • Multiple oral medicines are available.
  • In most cases, the brain rapidly compensates and adjusts to the new vestibular deficit, or the inflammatory process resolves.
  • Evidence indicates many sedating medicines commonly used for this condition may slow recovery. Thus, medical treatment may reduce symptoms but prolong recovery.

Prognosis

  • Most patients recover from severe vertigo and imbalance within 1 week.
  • A minority have recurrent, less severe attacks or persistent symptoms. The likelihood of incomplete long-term recovery can be predicted based on initial bedside testing.9

Patient Education

  • In general, movement and activity, to the extent they can be tolerated by the patient, may hasten cerebral compensation and recovery.
    • Eventually, patients can be taught exercises of the eyes and neck to hasten cerebral compensation and recovery.
    • Exercises are seldom practical during the acute episode because of patient discomfort.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider vertigo of central origin is the most important diagnostic error a clinician can make. Vestibular neuronitis generally is a benign and self-limited condition. Diseases involving the cerebellum and brainstem can be life threatening and always must be considered.10,7
  • Failure to exclude other cranial nerve deficits. The presence of other cranial nerve deficits essentially excludes the diagnosis of vestibular neuronitis
  • Failure to note presence of hearing loss, which suggests involvement of the cochlea and other inner ear structures, a condition described as labyrinthitis. The possibility of bacterial infection increases with this finding. Admission or consultation for diagnostic assistance and further treatment is recommended. Consider empiric parenteral antibiotics as well if possible CNS infection.
 


More on Vestibular Neuronitis

Overview: Vestibular Neuronitis
Differential Diagnoses & Workup: Vestibular Neuronitis
Treatment & Medication: Vestibular Neuronitis
Follow-up: Vestibular Neuronitis
References
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References

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Further Reading

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Keywords

vestibular neuronitis, vestibular neuropathy, inflammation of the vestibular nerve, vertigo, dizziness, reactivation of latent herpes simplex virus type 1, herpes simplex virus, vertiginous episodes, rapid head movement  

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Contributor Information and Disclosures

Author

Keith A Marill, MD, Faculty, Department of Emergency Medicine, Massachusetts General Hospital
Keith A Marill, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Medtronic Ownership interest None; Cambridge Heart, Inc. Ownership interest None

Medical Editor

Peter MC DeBlieux, MD, Professor of Clinical Medicine and Pediatrics, Section of Pulmonary and Critical Care Medicine, Program Director, Department of Emergency Medicine, Louisiana State University Health Sciences Center
Peter MC DeBlieux, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Radiological Society of North America, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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