Diagnosis

Vestibular neuronitis

Etiology

Cause [bwu]

• Presumed viral infection: the reactivation of latent HSV infection, respiratory viruses (influenza, adenovirus)

• Other theories: vascular or immunologic etiology

Pathophysiology [bwu]

1. Inflammation of the vestibular portion of the 8th cranial nerve

2. Imbalance of neuronal input between the left and right inner ears --> Nausea, vomiting, and severe spinning vertigo

Complications [bwu]

• Benign paroxysmal positional vertigo (BPPV)

• Persistent postural-perceptual dizziness (PPPD)

Epidemiology

Incidence per 100.000 [kzm][s3a][rop][mm4][iee][1nd]

Approach

• Clinical diagnosis: [bwu]

  • Constant symptoms

  • Worsened with head movement (no triggered)

  • Symptoms last several days before resolving

  • Negative HINTs exam (Head Impulse, Nystagmus, and Test of Skew)

• Otoscopy

• Neurologic exam: Cranial nerve, cerebellum, gait, balance

• Examination for nystagmus, electronystagmography, caloric testing

• Audiometry

• CT caput

• MR caput

Treatment

1. Symptomatic treatment: max 3 days

   • Antiemetic: promethazine, metoclopramide

   • Antihistamine: diphenhydramine, meclizine

   • Benzodiazepines: diazepam, lorazepam

2. Vestibular rehabilitation

   • Gaze stability exercises: keeping eyes fixated on a target while moving the head

   • Habituation: provoke symptoms and then reduce response upon repetition

   • Functional retraining – including postural control, relaxation, and balance training

Differential diagnoses

Acoustic neuroma, Benign paroxysmal positional vertigo, Cholesteatoma, Labyrinthitis, Lyme disease, Meniere disease, Migraine, Multiple sclerosis, Stroke