Vestibular neuritis

Vestibular neuritis, also called labyrinthitis or acute unilateral vestibulopathy, is a disorder characterised by sudden loss of function of the vestibular nerve on one side. It's usually acute, but almost always completely reversible. It's a common cause of vertigo and acute vestibular syndrome.

Etiology

As the name implies, vestibular neuritis is assumed to be secondary to inflammation. The prevailing theory is that it's caused by reactivation of latent herpes simplex virus or other viruses. Many patients (up to 40%) have a preceding viral URTI. However, there are few real data to support this mechanism. So the cause is not really well known.

Clinical features

Symptoms include sudden onset (acute or subacute) persistent vertigo, nausea/vomiting, intolerance to head movement, spontaneous nystagmus, and a tendence to fall to the diseased side. The vertigo lasts for multiple days. The nystagmus is directed toward the healthy ear. There is no hearing loss and no focal neurological features. There may be a history of viral URTI recently.

Diagnosis and evaluation

Vestibular neuritis is a clinical diagnosis. Performing the HINTS test is obligatory to rule out central causes of vertigo. As a peripheral cause of vertigo, vestibular neuritis is HINTS positive.

Management

Vestibular neuritis is self-limiting and harmless, but hospital admission may be necessary if one cannot rule out a posterior circulation stroke clinically or if the patient is so severely affected that they cannot function at home.

In the acute phase, bed rest and an antiemetic is indicated. After the condition improves, early vestibular rehabilitation (exercises to train the vestibular system) and movement is important to hasten recovery. A corticosteroid may hasten recovery, but it's unknown whether it improves long-term prognosis. A 10 day taper of prednisolone may be used. ‎