Vestibular Neuronitis Clinical Presentation

Updated: Mar 23, 2017
  • Author: Keith A Marill, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Presentation

History

Patients usually complain of abrupt onset of severe, debilitating vertigo with associated unsteadiness, nausea, and vomiting. [4] They often describe their vertigo as a sense that either they or their surroundings are spinning. Vertigo increases with head movement.

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Physical

Spontaneous, unidirectional, horizontal nystagmus is the most important physical finding. [5, 6] 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

The head impulse test is a test for normal ocular fixation in association with rapid passive head rotation. An abnormal response is indicated by an inability to maintain fixation during head rotation with a corrective gaze shift after the head stops moving. An abnormal test seems to be sensitive, but not perfectly specific, for a peripheral vestibular disorder. [7, 8]

One group has combined the head impulse test with an assessment of nystagmus type and a test of skew to form the HINTS test, a three component eye movement battery of tests. [8, 9, 10] This clinical battery of tests appears helpful in differentiating vestibular neuritis from a more dangerous central process such as cerebellar stroke, though it awaits further independent confirmation. [8, 9]

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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.

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