eMedicine Specialties > Emergency Medicine > Neurology

Vestibular Neuronitis

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

Updated: Mar 3, 2008

Introduction

Background

Vestibular neuronitis may be described as acute, sustained dysfunction of the peripheral vestibular system with secondary nausea, vomiting, and vertigo. As this condition is not clearly inflammatory in nature, neurologists often refer to it as vestibular neuropathy.

Pathophysiology

Its etiology remains largely unknown, yet vestibular neuronitis appears to be a sudden disruption of afferent neuronal input from 1 of the 2 vestibular apparatuses. This imbalance in vestibular neurologic input to the central nervous system (CNS) causes symptoms of vertigo. At least some cases are thought to be due to reactivation of latent herpes simplex virus type 1 in the vestibular ganglia.

Mortality/Morbidity

Most patients experience complete recovery within a few weeks. A minority have recurrent vertiginous episodes following rapid head movement for years after onset.

Sex

Studies have shown no consistent male or female predominance.

Age

This syndrome occurs most commonly in middle-aged adults; mean age of onset is 41 years.

Clinical

History

  • Patients usually complain of abrupt onset of severe, debilitating vertigo with associated unsteadiness, nausea, and vomiting.
    • They often describe their vertigo as a sense that either they or their surroundings are spinning.
    • Vertigo increases with head movement.

Physical

  • Spontaneous, unidirectional, horizontal nystagmus is the most important physical finding.
    • Fast phase oscillations beat toward the healthy ear.
    • Nystagmus may be positional and apparent only when gazing toward the healthy ear, or during Hallpike maneuvers.
    • Patients may suppress their nystagmus by visual fixation.
  • Patient tends to fall toward his or her affected side when attempting ambulation or during Romberg tests.
  • Affected side has either unilaterally impaired or no response to caloric stimulation.
  • Vestibular neuronitis is unlikely if any of the following findings are present. The following symptoms should be absent:
    • Multidirectional, nonfatiguing nystagmus suggesting vertigo of central origin
    • Hearing loss
    • Other cranial nerve deficits
    • Truncal ataxia (suggests cerebellar disease or another CNS process)
    • Inflamed tympanic membrane
    • Mastoid tenderness
    • High fever
    • Nuchal rigidity

Causes

  • Viral infection of the vestibular nerve and/or labyrinth is believed to be the most common cause of vestibular neuronitis.
  • Acute localized ischemia of these structures also may be an important cause.
  • Especially in children, vestibular neuritis may be preceded by symptoms of a common cold. However, the causative mechanism remains uncertain.

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

  1. Babe KS Jr, Serafin WE. Histamine, bradykinin, and their antagonists. In: Goodman & Gilman's The Pharmacological Basis of Therapeutics. 1996. 581-600.

  2. Baloh RW, Ishyama A, Wackym PA, Honrubia V. Vestibular neuritis: clinical-pathologic correlation. Otolaryngol Head Neck Surg. Apr 1996;114(4):586-92. [Medline].

  3. Baloh RW. Clinical practice. Vestibular neuritis. N Engl J Med. Mar 13 2003;348(11):1027-32. [Medline].

  4. Bohmer A. Acute unilateral peripheral vestibulopathy. In: Disorders of the Vestibular System. 1996:318-27.

  5. Cohen B, DeJong JM. Meclizine and placebo in treating vertigo of vestibular origin. Relative efficacy in a double-blind study. Arch Neurol. Aug 1972;27(2):129-35. [Medline].

  6. Division of Drugs and Toxicology. Drugs used for motion disorders and vomiting. Drug Evaluations Annual. 1995:465-92.

  7. El-Kashlan HK, Telian SA. Diagnosis and initiating treatment for peripheral system disorders: imbalance and dizziness with normal hearing. Otolaryngol Clin North Am. Jun 2000;33(3):563-78. [Medline].

  8. Froehling DA, Silverstein MD, Mohr DN. Does this dizzy patient have a serious form of vertigo?. JAMA. Feb 2 1994;271(5):385-8. [Medline].

  9. Gizzi M, Riley E, Molinari S. The diagnostic value of imaging the patient with dizziness. A Bayesian approach. Arch Neurol. Dec 1996;53(12):1299-304. [Medline].

  10. Hotson JR, Baloh RW. Acute vestibular syndrome. N Engl J Med. Sep 3 1998;339(10):680-5. [Medline].

  11. Marill KA, Walsh MJ, Nelson BK. Intravenous lorazepam versus dimenhydrinate for treatment of vertigo in the emergency department: A randomized clinical trial. Ann Emerg Med. 2000;36:310-9. [Medline].

  12. Peppard SB. Effect of drug therapy on compensation from vestibular injury. Laryngoscope. Aug 1986;96(8):878-98. [Medline].

  13. Philpot SJ, Archer JS. Herpes encephalitis preceded by ipsilateral vestibular neuronitis. J Clin Neurosci. Nov 2005;12(8):958-9. [Medline].

  14. Rascol O, Hain TC, Brefel C. Antivertigo medications and drug-induced vertigo. A pharmacological review. Drugs. Nov 1995;50(5):777-91. [Medline].

  15. Ryu JH, McCabe BF. effects of diazepam and dimenhydrinate on the resting activity of the vestibular neuron. Aerosp Med. Oct 1974;45(10):1177-9. [Medline].

  16. Schwaber MK. Vestibular Disorders. Clinical Otology. 1997:345-65.

  17. Strupp M, Zingler VC, Arbusow V, Niklas D, Maag KP, Dieterich M. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med. Jul 22 2004;351(4):354-61. [Medline].

  18. Troost BT. Dizziness and Vertigo. Neurology in Clinical Practice. 1996;1:219-32.

  19. Troost BT, Waller MA. Neuro-Otology. Neurology in Clinical Practice. 1996;1:647-57.

  20. Huppert D, Strupp M, Theil D, Glaser M, Brandt T. Low recurrence rate of vestibular neuritis: a long-term follow-up. Neurology. Nov 28 2006;67(10):1870-1. [Medline].

  21. Sekitani T, Imate Y, Noguchi T, Inokuma T. Vestibular neuronitis: epidemiological survey by questionnaire in Japan. Acta Otolaryngol Suppl. 1993;503:9-12. [Medline].

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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: Nothing to disclose.

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: Nothing to disclose.

Managing Editor

J Stephen Huff, MD, Associate Professor of 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, Medical Director, 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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