Vestibular Neuronitis

The cause of this condition is largely unknown, but often follows febrile illness in adults and may be due to a reactivation of latent HSV1 in the vestibular ganglia.  It causes similar symptoms to labyrinthitis but is usually differentiated in that there is completely preserved hearing in VN.

Symptoms

The patient usually complains of acute onset, severe vertigo (sense of falling/spinning) which can be debilitating as to cause vomiting and exhaustion, often made even worse by head movements.

Signs

 

Unidirectional, horizontal nystagmus is the most convincing sign.  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 in Romberg’s test.

The diagnosis is made less likely if there is hearing loss, cerebellar signs or other CN palsies.

Management

Rehydration and steroid treatment (IV methylprednisolone) and/or cyclizine (antihistamine) are the only known effective treatments in the acute setting.  However, there is no known long term benefit from this.  It will normally improve quite quickly but resolve over a couple of weeks.

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