Vestibular neuritis: Difference between revisions
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***May change direction with gaze | ***May change direction with gaze | ||
**Ataxia | **Ataxia | ||
**Patient may have limb dysmetria, dysarthria, or | **Patient may have limb dysmetria, dysarthria, or headache | ||
**Head impulse test usually normal | **Head impulse test usually normal | ||
*Brainstem infarction | *Brainstem infarction | ||
Revision as of 23:37, 30 July 2016
Some sources consider vestibular neuritis and labyrinthitis to be the same thing (some differentiate based on auditory symptoms)
Background
- Benign, self-limited disorder associated with complete recovery in most patients
- Must distinguish from acute vascular lesions of the CNS
- Pathophysiology
- May be viral or postviral inflammatory disorder affecting vestibular portion of CN VIII
Clinical Features
- Acute, rapid onset of severe vertigo with nausea/vomiting and gait instability
- Nystagmus
- Unilateral, horizontal or horizontal-torsional that is suppressed with visual fixation
- Does not change direction with gaze
- Unlike BPPV and Meniere lasts several days and does not recur
Differential Diagnosis
Vertigo
- Vestibular/otologic
- Benign paroxysmal positional vertigo (BPPV)
- Traumatic (following head injury)
- Infection
- Ménière's disease
- Ear foreign body
- Otic barotrauma
- Otosclerosis
- Neurologic
- Cerebellar stroke
- Vertebrobasilar insufficiency
- Lateral Wallenberg syndrome
- Anterior inferior cerebellar artery syndrome
- Neoplastic: cerebellopontine angle tumors
- Basal ganglion diseases
- Vertebral Artery Dissection
- Multiple sclerosis
- Infections: neurosyphilis, tuberculosis
- Epilepsy
- Migraine (basilar)
- Other
- Hematologic: anemia, polycythemia, hyperviscosity syndrome
- Toxic
- Chronic renal failure
- Metabolic
Evaluation
- Cerebellum lesion
- Nystagmus
- Not suppressed with visual fixation
- May be other than horizontal or horizontal-torsional
- May change direction with gaze
- Ataxia
- Patient may have limb dysmetria, dysarthria, or headache
- Head impulse test usually normal
- Nystagmus
- Brainstem infarction
- Usually associated with other symptoms of Wallenberg syndrome (lateral medulla infarct)
- Ipsilateral Horner's, loss of corneal reflex, dysphagia, contralateral loss of pain/temp
- Usually associated with other symptoms of Wallenberg syndrome (lateral medulla infarct)
Management
- Treat associated vertigo symptomatically