UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Vestibular neuritis and labyrinthitis

Author
Joseph M Furman, MD, PhD
Section Editors
Michael J Aminoff, MD, DSc
Daniel G Deschler, MD, FACS
Deputy Editor
Janet L Wilterdink, MD

INTRODUCTION

Vestibular neuritis is also known as vestibular neuronitis, labyrinthitis, neurolabyrinthitis, and acute peripheral vestibulopathy. It is a benign disorder, self-limited, and associated with a complete recovery in most patients. Nonetheless, its symptoms of vertigo, nausea, vomiting, and gait impairment can be disabling in the short term.

Vestibular neuritis also shares clinical features with less benign disorders, particularly acute vascular lesions of the central nervous system, from which it must be accurately differentiated in order to avoid morbidity and mortality.

This topic will review the pathophysiology, clinical manifestations, diagnosis, and treatment of vestibular neuritis. The evaluation and differential diagnosis of vertigo are discussed separately. (See "Evaluation of the patient with vertigo" and "Pathophysiology, etiology, and differential diagnosis of vertigo".)

PATHOPHYSIOLOGY

Vestibular neuritis is generally understood to be a viral or postviral inflammatory disorder affecting the vestibular portion of the eighth cranial nerve. This pathophysiological mechanism is not necessarily accurate [1]. There are little pathologic data to support this mechanism in patients with this disorder, and a history of a preceding viral illness is elicited in less than one-half of patients [2-4].

CLINICAL MANIFESTATIONS

Vestibular neuritis, also known as vestibular neuronitis and labyrinthitis, represents an acute, spontaneous, peripheral vestibular ailment, characterized by the rapid onset of severe vertigo with nausea, vomiting, and gait instability.

           

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Fri Aug 09 00:00:00 GMT 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Baloh RW. Clinical practice. Vestibular neuritis. N Engl J Med 2003; 348:1027.
  2. Hotson JR, Baloh RW. Acute vestibular syndrome. N Engl J Med 1998; 339:680.
  3. DIX MR, HALLPIKE CS. The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med 1952; 45:341.
  4. Silvoniemi P. Vestibular neuronitis. An otoneurological evaluation. Acta Otolaryngol Suppl 1988; 453:1.
  5. Mandalà M, Nuti D, Broman AT, Zee DS. Effectiveness of careful bedside examination in assessment, diagnosis, and prognosis of vestibular neuritis. Arch Otolaryngol Head Neck Surg 2008; 134:164.
  6. Newman-Toker DE, Kattah JC, Alvernia JE, Wang DZ. Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis. Neurology 2008; 70:2378.
  7. Kattah JC, Talkad AV, Wang DZ, et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40:3504.
  8. Gold DR, Reich SG. Clinical reasoning: a 55-year-old woman with vertigo. A dizzying conundrum. Neurology 2012; 79:e146.
  9. Tarnutzer AA, Berkowitz AL, Robinson KA, et al. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 2011; 183:E571.
  10. Lee CC, Su YC, Ho HC, et al. Risk of stroke in patients hospitalized for isolated vertigo: a four-year follow-up study. Stroke 2011; 42:48.
  11. Lee H, Sohn SI, Cho YW, et al. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology 2006; 67:1178.
  12. Casani AP, Dallan I, Cerchiai N, et al. Cerebellar infarctions mimicking acute peripheral vertigo: how to avoid misdiagnosis? Otolaryngol Head Neck Surg 2013; 148:475.
  13. Norrving B, Magnusson M, Holtås S. Isolated acute vertigo in the elderly; vestibular or vascular disease? Acta Neurol Scand 1995; 91:43.
  14. Kerber KA, Brown DL, Lisabeth LD, et al. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 2006; 37:2484.
  15. Lee H, Kim HA. Nystagmus in SCA territory cerebellar infarction: pattern and a possible mechanism. J Neurol Neurosurg Psychiatry 2013; 84:446.
  16. Furman JM, Cass SP. Benign paroxysmal positional vertigo. N Engl J Med 1999; 341:1590.
  17. Schwartz NE, Venkat C, Albers GW. Transient isolated vertigo secondary to an acute stroke of the cerebellar nodulus. Arch Neurol 2007; 64:897.
  18. Kim JS. Vertigo and gait ataxia without usual signs of lateral medullary infarction: a clinical variant related to rostral-dorsolateral lesions. Cerebrovasc Dis 2000; 10:471.
  19. Becker KJ, Purcell LL, Hacke W, Hanley DF. Vertebrobasilar thrombosis: diagnosis, management, and the use of intra-arterial thrombolytics. Crit Care Med 1996; 24:1729.
  20. Kim HA, Hong JH, Lee H, et al. Otolith dysfunction in vestibular neuritis: recovery pattern and a predictor of symptom recovery. Neurology 2008; 70:449.
  21. Nuti D, Mandalà M, Broman AT, Zee DS. Acute vestibular neuritis: prognosis based upon bedside clinical tests (thrusts and heaves). Ann N Y Acad Sci 2005; 1039:359.
  22. Palla A, Straumann D, Bronstein AM. Vestibular neuritis: vertigo and the high-acceleration vestibulo-ocular reflex. J Neurol 2008; 255:1479.
  23. Huppert D, Strupp M, Theil D, et al. Low recurrence rate of vestibular neuritis: a long-term follow-up. Neurology 2006; 67:1870.
  24. Baloh RW, Honrubia V, Jacobson K. Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology 1987; 37:371.
  25. Godemann F, Schuller J, Uhlemann H, et al. Psychodynamic vulnerability factors in the development of panic disorders--a prospective trial in patients after vestibular neuritis. Psychopathology 2009; 42:99.
  26. Strupp M, Zingler VC, Arbusow V, et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med 2004; 351:354.
  27. Shupak A, Issa A, Golz A, et al. Prednisone treatment for vestibular neuritis. Otol Neurotol 2008; 29:368.
  28. Fishman JM, Burgess C, Waddell A. Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Database Syst Rev 2011; :CD008607.
  29. 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.
  30. Irving C, Richman P, Kaiafas C, et al. Intramuscular droperidol versus intramuscular dimenhydrinate for the treatment of acute peripheral vertigo in the emergency department: a randomized clinical trial. Acad Emerg Med 2002; 9:650.
  31. Strupp M, Arbusow V, Maag KP, et al. Vestibular exercises improve central vestibulospinal compensation after vestibular neuritis. Neurology 1998; 51:838.